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Exam Code: NCCT-ICS Practice test 2023 by team
NCCT-ICS NCCT Insurance and Coding Specialist

Test Detail:
The NCCT-ICS (NCCT Insurance and Coding Specialist) test is a certification test offered by the National Center for Competency Testing (NCCT). It is designed to assess the knowledge and skills of individuals in the field of medical insurance and coding. The test evaluates the candidate's understanding of insurance regulations, coding systems, reimbursement processes, and medical documentation requirements.

Course Outline:
The NCCT-ICS course provides comprehensive training on medical insurance and coding. It covers a wide range of syllabus related to insurance procedures, coding guidelines, and reimbursement practices. While the specific course content may vary, the following is a general outline of the key syllabus covered:

1. Introduction to Medical Insurance:
- Overview of the healthcare insurance industry.
- Understanding insurance terminology and concepts.
- Introduction to healthcare reimbursement systems.
- Legal and ethical considerations in medical insurance.

2. Medical Coding Fundamentals:
- Introduction to medical coding systems (e.g., ICD-10, CPT, HCPCS).
- Coding guidelines and conventions for accurate code assignment.
- Coding for diagnoses, procedures, and services.
- Coding compliance and auditing processes.

3. Medical Insurance Claims Processing:
- Overview of the insurance claims process.
- Understanding different types of insurance plans (e.g., HMO, PPO).
- Completing insurance claim forms accurately and efficiently.
- Managing claim denials, appeals, and reimbursement issues.

4. Health Information Management:
- Medical record documentation and organization.
- Privacy and security of patient health information (HIPAA).
- Electronic health records (EHR) and health information exchange.
- Data quality and integrity in health information management.

5. Reimbursement and Billing Practices:
- Overview of healthcare reimbursement methodologies.
- Understanding fee schedules, billing codes, and charge capture.
- Insurance verification and pre-authorization processes.
- Managing accounts receivable and collections.

Exam Objectives:
The NCCT-ICS test assesses candidates' knowledge and skills in medical insurance and coding. The test objectives include, but are not limited to:

1. Medical Insurance Principles:
- Understanding insurance terminology, policies, and regulations.
- Demonstrating knowledge of insurance claim processing procedures.
- Applying legal and ethical standards in medical insurance practices.

2. Medical Coding and Documentation:
- Applying coding guidelines and conventions for accurate code assignment.
- Demonstrating proficiency in coding diagnoses, procedures, and services.
- Understanding medical record documentation requirements.

3. Insurance Claims Processing:
- Completing insurance claim forms accurately and efficiently.
- Demonstrating knowledge of insurance claim submission and processing.
- Managing claim denials, appeals, and reimbursement issues.

4. Health Information Management:
- Understanding the principles of health information management.
- Complying with privacy and security regulations (HIPAA).
- Demonstrating proficiency in electronic health records (EHR) usage.

5. Reimbursement and Billing Practices:
- Understanding healthcare reimbursement methodologies and fee schedules.
- Applying proper billing codes and charge capture processes.
- Managing insurance verification, pre-authorization, and accounts receivable.

The NCCT-ICS course syllabus provides a detailed breakdown of the syllabus covered in the training program. It includes specific learning objectives, case studies, practical exercises, and hands-on coding practice. The syllabus may cover the following areas:

- Introduction to medical insurance and coding.
- Medical coding systems (ICD-10, CPT, HCPCS).
- Insurance claims processing and reimbursement.
- Health information management and documentation.
- Compliance and ethics in medical insurance.
- test preparation and practice tests.
- Final NCCT-ICS Insurance and Coding Specialist Certification Exam.
NCCT Insurance and Coding Specialist
P-and-C Specialist guide
Killexams : P-and-C Specialist guide - BingNews Search results Killexams : P-and-C Specialist guide - BingNews Killexams : Insurity Hurricane Guide: Automation and Analytics Empower P&C Insurers to Combat the Rising Costs of Hurricanes

HARTFORD, Conn.--(BUSINESS WIRE)--Jul 25, 2023--

Insurity, the leading provider of cloud-based software for insurance carriers, brokers, and MGAs, recently released its Hurricane Guide for the 2023 season. Employing proprietary and industry research, the report shows the best practices insurance organizations can implement to move from a “react and respond” mentality to a “prepare and serve” approach this hurricane season. This approach will prepare insurers to face a worrying trend: billion-dollar events in concentrated areas of wealth. In fact, 75% of all global insured losses were recorded in the U.S. in 2022, with Hurricane Ian being responsible for nearly 50% of all global insured losses.

Even with the best technology and in-house GIS experts, hurricanes create a scramble. When hurricanes strike, P&C insurers face the challenge of quickly converting data files into usable information then providing insights to business partners. This process repeats every time the organization receives hazard updates. Insurity Geospatial Event Response, powered by SpatialKey, removes the technical and time-consuming burden of working with massive streams of complex hazard and event data. The entire process is automated and emailed within minutes of each update.

“How effectively you prepare for and respond to hurricanes can either be an asset or a detriment to your business,” said Kirstin Marr, Chief Analytics Officer at Insurity. “A proactive approach that streamlines and automates access to expert data and advanced analytics as events unfold is imperative to managing costs and customer satisfaction.”

The 2023 Hurricane Guide provides checklists for insurers to use before, during, and after a hurricane. It also includes the necessary steps for conducting a hurricane dry run, allowing insurers to stress test with past scenarios to gain insight into the composition of their portfolio of risks and identify the location characteristics likely to drive losses.

The guide stresses the importance of having data and analytics in place to understand and gain an accurate idea of potential concentrations of loss immediately following a hurricane. This helps anticipate the extent of claims and pinpoint exactly where those claims will be coming from - without the need to have boots on the ground to get the initial estimates.

“Having a robust data and analytics solution that goes beyond public or open-source data and simple analytics is paramount before, during, and after large-scale events,” said Marr. “During hurricanes Ian and Nicole, many Insurity customers had access to event footprints as they became available from our library of data providers, like NOAA, JBA, and KatRisk. These up-to-date footprints coupled with policy exposed limits help insurers understand actual exposure and focus their response efforts.”

To learn more about how Insurity Analytics can benefit your organization during a hurricane, get in touch with Elizabeth Hutchinson at

About Insurity

Insurity is a leading provider of cloud-based software for insurance carriers, brokers, and MGAs. Insurity is trusted by 22 of the top 25 P&C carriers and 7 of the top 10 MGAs in the US and has over 400 cloud-based deployments. Through its best-in-class digital platform and with unrivaled industry experience and the industry's most robust analytics offerings, Insurity is uniquely positioned to deliver exceptional value, empowering customers to focus on their core businesses, optimize their operations, and provide superior policyholder experiences. Insurity is a portfolio company of GI Partners and TA Associates. For more information, visit

View source version on

CONTACT: Elizabeth Hutchinson



SOURCE: Insurity

Copyright Business Wire 2023.

PUB: 07/25/2023 10:17 AM/DISC: 07/25/2023 10:15 AM

Copyright Business Wire 2023.

Tue, 25 Jul 2023 05:04:00 -0500 en text/html
Killexams : GLP-1 Agonists For Weight Loss: What You Need To Know

GLP-1 agonists work by mimicking the effects of a hormone called GLP-1, which is produced naturally in the body in response to food consumption. This hormone is involved in regulating insulin secretion, feelings related to hunger and the emptying of the stomach. GLP-1 agonists bind to GLP-1 receptors in the body, thereby resulting in the same effects.

“By activating receptors in the pancreas, [GLP-1 agonists are] able to regulate insulin and control blood sugar,” explains Spencer Nadolsky, D.O., an obesity specialist physician based in Portage, Michigan and medical director of Sequence, an online weight loss program. “But they also activate receptors in the brain to curb appetite and in the gut to slow stomach emptying.”

A GLP-1 agonist can impact satiety and cravings to support weight loss, he adds. “It helps you eat fewer calories by making you feel more satisfied with decreased cravings.”

How Effective Are GLP-1 Agonists for Weight Loss?

“Studies demonstrate that a GLP-1 agonist along with a diet and exercise program will result in up to 15% body weight loss,” says Jason Balette, M.D., a bariatric surgeon at Memorial Hermann in Houston, Texas. “The patients in these same studies with diet and exercise alone lost on average about 2.4% body weight.” (note that this study was funded by Novo Nordisk, a pharmaceutical company that produces GLP-1 agonists).

One study comparing the effects of the GLP-1 agonists semaglutide and liraglutide—both of which are approved specifically for weight loss—found that participants (all of which did not have diabetes but did have obesity) lost an average of 15.8% and 6.4% of their body weight, respectively, after 68 weeks . Another study on the effectiveness of liraglutide found that 62% of participants lost at least 5% of their body weight after six months, while around 17% experienced at least 10% weight loss .

Wed, 16 Aug 2023 07:08:00 -0500 en-US text/html
Killexams : Nurture Changes a Parent's Brain


Seifritz, E. et al. Differential sex-​independent amygdala response to infant crying and laughing in parents versus nonparents. Biol Psychiat 54, 1367– 1375 (2003);

Glasper, E. R., Kenkel, W. M., Bick, J. & Rilling, J. K. More than just mothers: The neurobiological and neuroendocrine underpinnings of allomaternal caregiving. Front Neuroendocrinol 53, 100741 (2019);

Feldman, R. The adaptive human parental brain: Implications for children’s social development. Trends Neurosci 38, 387– 399 (2015);

Young, K. S. et al. The neural basis of responsive caregiving behaviour: Investigating temporal dynamics within the parental brain. Behav Brain Res 325, 105– 116 (2016).

Feldman, R., Braun, K. & Champagne, F. A. The neural mechanisms and consequences of paternal caregiving. Nat Rev Neurosci 20, 205– 224 (2019).

Hoekzema, E. et al. Pregnancy leads to long-​lasting changes in human brain structure. Nat Neurosci 20, 287– 296 (2016).

Glasper, E. R., Kenkel, W. M., Bick, J. & Rilling, J. K. More than just mothers: The neurobiological and neuroendocrine underpinnings of allomaternal caregiving. Front Neuroendocrinol 53, 100741 (2019)


Hernandez-​Gonzalez, M., Hidalgo-​Aguirre, R. M., Guevara, M. A., P.rez-​Hern.ndez, M. & Amezcua-​Guti.rrez, C. Observing videos of a baby crying or smiling induces similar, but not identical, electroencephalographic responses in biological and adoptive mothers. Infant Behav Dev 42, 1– 10 (2015);

Grasso, D. J., Moser, J. S., Dozier, M. & Simons, R. ERP correlates of attention allocation in mothers processing faces of their children. Biol Psychol 81, 95– 102

Marlin, B. J., Mitre, M., D’amour, J. A., Chao, M. V. & Froemke, R. C. Oxytocin enables maternal behaviour by balancing cortical inhibition. Nature 520, 499– 504

(2014); Pisapia, N. D. et al. Sex differences in directional brain responses to infant hunger cries. Neuroreport 24, 142– 146 (2013).

Kim, P. et al. Neural plasticity in fathers of human infants. Soc Neurosci 9, 522– 535

(2014); Paternina-​Die, M. et al. The paternal transition entails neuroanatomic adaptations that are associated with the father’s brain response to his infant cues. Cereb

Cortex Commun 1, tgaa082 (2020).


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Pisapia, N. D. et al. Sex differences in directional brain responses to infant hunger cries. Neuroreport 24, 142– 146 (2013).

Schiavo, J. K. et al. Innate and plastic mechanisms for maternal behaviour in auditory cortex. Nature 587, 426– 431 (2019).

Hoekzema, E. et al. Pregnancy leads to long-​lasting changes in human brain structure.

Nat Neurosci 20, 287– 296 (2016); Kim, P. et al. Neural plasticity in fathers of human infants. Soc Neurosci 9, 522– 535 (2014).

Abraham, E., Raz, G., Zagoory-​Sharon, O. & Feldman, R. Empathy networks in the parental brain and their long-​term effects on children’s stress reactivity and behavior adaptation. Neuropsychologia 116, 75– 85 (2018); McMahon, C. A. & Bernier,

A. Twenty years of research on parental mind-​mindedness: Empirical findings, theoretical and methodological challenges, and new directions. Dev Rev 46, 54–80 (2017);

Farrow, C. & Blissett, J. Maternal mind-​mindedness during infancy, general parenting sensitivity and observed child feeding behavior: A longitudinal study.

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Seifritz, E. et al. Differential sex-​independent amygdala response to infant crying and laughing in parents versus nonparents. Biol Psychiat 54, 1367– 1375 (2003);

Noriuchi, M., Kikuchi, Y. & Senoo, A. The functional neuroanatomy of maternal love: Mother’s response to infant’s attachment behaviors. Biol Psychiat 63, 415– 423 (2007).


Hoekzema, E. et al. Becoming a mother entails anatomical changes in the ventral striatum of the human brain that facilitate its responsiveness to offspring cues. Psychoneuroendocrinology 112, 104507 (2019);

Rincon-​Cortes, M. & Grace, A. A. Adaptations in reward-​related behaviors and mesolimbic dopamine function during motherhood and the postpartum period. Front Neuroendocrinol 57, 100839 (2020);

Bartels, A. & Zeki, S. The neural correlates of maternal and romantic love. Neuroimage 21, 1155– 1166 (2004); Atzil, S. et al. Dopamine in the medial amygdala network mediates human bonding. Proc Natl Acad Sci USA 114, 2361–2366 (2017).

Abraham, E. et al. Father’s brain is sensitive to childcare experiences. Proc Natl Acad Sci USA 111, 9792– 9797 (2014).

Mon, 14 Aug 2023 06:25:00 -0500 en text/html
Killexams : Washing machine temperature guide

The majority of us wash the bulk of our clothes at 40°C. But cooler or hotter temperatures may be best for some items.

Our  guide will help you to decide which is best for jeans, whites, coloureds or baby clothes.

If you want a new washing machine, head straight over to our washing machine reviews.

Not sure what type of washing machine you need? See our guide to the best washing machines.

Can I wash clothes at 20°C?

Yes, depending on if your clothes are stained. 

All washing machines in the UK must, since 2013, have a 20°C option on the control panel to help save energy. 

Our tests found that turning the temperature down on the cottons program from 40°C to 20°C reduced running costs by an average of 62%. This is because washing machines need to use less energy to heat water to lower temperatures.

Cleaning power was slightly worse at 20°C but switching to a liquid detergent helped, and it should still be enough for everyday cleaning.

If you wash at low temperatures, it becomes even more important to run a regular monthly maintenance wash with a washing machine cleaner.

Benefits of washing at 30°C

Washing at 30°C uses 38% less energy than washing at 40°C, so you make a substantial saving on your bill and help the planet.

More than a quarter of Which? members regularly use a 30°C program. It's the recommended setting for a lot of delicate clothes - such as wool and silk – always check the label, though. 

Lower temperatures are also good at helping preserve colourfully dyed fabrics and a good-quality laundry detergent can help with this, too.

Find out more on the benefits of washing at lower temperatures.

Difference between washing at 40°C and 30°C

Lower temperatures will be fine for everyday cleaning, but a 40°C wash will be better for tougher stains. And as most Which? members we asked frequently use the 40°C temperature setting, we base our own testing on the 40°C cottons and synthetics wash programs.

It’s also the temperature most clothes - such as cotton, linen, viscose or acrylics - are recommended to be washed at.

In our tests, a washing machine that scores five stars for cleaning removes 30% more stains than a one-star model on a 40°C washing cycle.

What to wash at 50°C?

This wash is suitable for polyester/cotton mixtures, nylon, cotton and viscose, but there isn't a good reason to switch to 50°C. 

Most stains will be shifted at 40°C and increasing the temperature will eat up more energy.

Cost of washing at 60°C

The 60°C program generally cleans slightly better than the 40°C program, especially on greasy stains, and is ideal for bedding and towels. But running costs increase by more than half. 

You might be washing at 60°C because you've heard it kills bacteria, but the temperature on its own doesn't. Some bacterial spores and viruses are resistant to washing at 60°C. 

You need to combine your 60°C wash with a good detergent to blast that bacteria. You might be better off choosing a good detergent, treating stains and washing at 40°C to get a great clean that doesn't cost a lot to run.

Does washing at 90°C kill bacteria?

This is the hottest wash program you’ll find on most machines and is only suitable for a few items – a lot of labels won't recommend washing at such a high temperature. 

But will washing at 90°C kill bacteria? The NHS website states that you should wash underwear, towels and household linen at 60°C to prevent the spread of germs or at 40°C with a bleach-based laundry product (we suggest bio washing powder). It says nothing about washing at as high as 90°C to kill bacteria. 

What temperature should I wash denim jeans at?

Denim can shrink and colours will fade, so to avoid shrinkage and to keep your blue jeans blue, don’t wash them at higher than 40°C.

If your washing machine has a specialist jeans program – and you have the time to split and separate your wash like this – it will use more water to flush away detergent and spins more gently to avoid creasing. 

How to wash clothes - find out more on how to wash denim jeans, baby clothes and underwear.

What temperature should I wash bed sheets at?

Select the 60°C cottons program for cotton bed sheets. By washing bed linen, such as sheets, pillowcases and duvet covers at 60°C – and by using a Best Buy washing powder and laundry detergent – you supply yourself a better chance of getting them clean without using the highest temperature setting.  

What temperature should I wash baby clothes at?

Aim for a 30°C or 40°C wash program for baby clothes. Any hotter and you risk shrinking what can be quite delicate clothes. 

You can wash your baby’s clothes with the rest of your laundry, or try the baby program if your machine has that option. 

This will be a little hotter, but rinses more thoroughly – more so than a normal wash setting – to make sure as much detergent as possible has been rinsed away.

What temperature should I wash underwear at?

If you end up with a pile of pants to wash, set your machine to wash at 60°C for the best results. If your load is very heavily soiled, wash at the highest temperature, which is 90°C on most machines.

Is 30°C a cold wash?

No, a cold wash should involve no heating of the water at all. Some detergents won’t be as effective at low temperatures. A cold wash is an option if you’re washing delicates or your clothes are brightly coloured and just need to be refreshed a little.

What temperature is warm in a washing machine?

40°C will feel warm and, with some exceptions, most laundry will end up being washed at 40°C.

What temperature is a hot wash?

Think about 60°C as a hot wash and 90°C as a very hot wash. Reserve the latter for occasions where your clothes’ fabrics are robust enough to stand up to the heat, but need the temperature to help shift the stains.

What temperature should I wash white clothes at?

Separating whites from coloured clothes is more important than the temperature you wash them at. If you separate them, you supply yourself the best chance of avoiding colours from other clothes bleeding into them.

The temperature you wash at will depend on how robust the terms are - and how dirty.

If you’re washing white bed sheets and other linen, 60°C will be fine. If you have a filthy white rugby or a football kit stained with mud, blood, grass and everything else a Saturday morning on the playing fields has to offer, similarly opt for a higher temperature.

What temperature should I wash mixed coloured clothes at?

Washing a mixture of bright colours together is fine and only becomes a problem if any whites end up in the load. 30°C would be a good temperature to wash and this will help the fabrics to retain their colour.

Find a great machine for washing coloured clothes among our best washing machines.

Other commonly used washing machine programs

Washing machines often have as many as 20 programs for washing, rinsing and spinning. These can include a baby clothes wash that has several rinses to make sure as much detergent is removed from the garments as possible, an easy iron program and intensive programs to help shift stubborn stains.

Mon, 31 Jul 2023 12:00:00 -0500 en text/html
Killexams : Palm Beach Post: Another wave of COVID-19 is on the way

It seems like long ago, when almost everything we did was colored by the threat of COVID-19.

In fact, it was barely two years ago when our high-tech society, whose medical advances had imbued many of us with a sense we would always have a treatment for whatever ailed us, was staggered like Europe during the Black Death. Our hospitals ran out of beds; out of ventilators for those lucky enough to get a bed; out of nurses to administer the ventilators and whatever other care might with luck spare a person’s life from the ravages of the lurking virus.

Thankfully, the pandemic subsided. Spreadsheets now show far fewer cases. Fewer bodies fill the morgues.

Naturally we’ve moved on. But let’s not move on just yet.

Another COVID wave is rocking Palm Beach County and Florida.

To be sure, the latest infections come with milder symptoms. But so much remains unknown. COVID is still new to us. We don’t know if those who recover might be revisited by the symptoms, or how to cure those who come down with a version that lingers endlessly, or whether newer, deadly variants might enter the mainstream.

Florida hospitals saw 7,674 cases between May 27 and July 22 this year, down from more than 35,000 during that period in 2022. We buried 635 people during the six weeks ending July 20, down from 2,072 a year earlier.

So, yes, much better, reason to cheer. But that’s still 635 family members, friends and colleagues who won’t be coming home.

So, ask yourself: When was the last time you got a booster shot? They’re still free, and they take just a few minutes to administer. CVS pharmacies, for example, administered more than 88 million vaccines and provided more than 61 million tests during the pandemic “and remain prepared to meet our patients needs for immunizations, testing and treatment of COVID-19,” said Matt Blanchette, senior manager for retail communications. Why not take advantage?

Alas, according to the U.S. Centers for Disease Control and Prevention, as of June 30, just 12.6% of Floridians have the latest booster that was approved last August. That’s the 10th-lowest rate among all states. Only one-third of Florida seniors are up to date on their shots, a rate lower than all but five states.

The advice from Dr. Larry Bush, an infectious disease specialist in Palm Beach County: If you’ve already been vaccinated, at this point it makes sense to wait until late summer, early fall, to get re-boosted, when new vaccines are coming out that more precisely target current variants. There is some crossover effectiveness between the original COVID-19 vaccines and newer strains but, says Bush, the newer shots will work better. That doesn’t mean you might not still get the disease, or experience a reaction to the shot, but if you’re weighing the protection versus potential ill effects, in his view, the benefits outweigh the risks.

Ask yourself also, why not still keep a mask in your purse, pocket or glove compartment, in case you find yourself at a crowded event, on a grocery store line where people are breathing down each other’s necks, or in a confined setting like the movies? There’s little question the combination of vaccination and masking, while by no means perfect, reduces the spread of the disease.

It’s true, says Bush, there’s no hard and fast proof that masks work well against COVID. A new study in Britain did demonstrate that after masking requirements for hospitals were dropped, the spread of COVID in hospitals went up. But that’s going to be true with every respiratory infection, he points out.

But look at it this way: If you put an umbrella over your head when it’s raining, the rain is not going to hit you. In the same way, if you put something in front of your face, you’re going to breathe in less COVID, and someone who has COVID will spill out less for others to catch.

So decide for yourself. No one’s mandating anything anymore. But by all means, let common sense guide you. If you don’t trust us, ask your doctor. Be well.

Tue, 22 Aug 2023 05:30:00 -0500 en text/html
Killexams : C2N Diagnostics launches new PrecivityAD2 blood test No result found, try new keyword!The test attained an overall performance statistic of 0.94 AUC and 88% accuracy in a study involving two independent cohorts. Thu, 17 Aug 2023 22:53:55 -0500 en-us text/html Killexams : Yoga For Beginners: Types, Benefits And How To Practice

Ready to supply yoga a try? Here are five yoga poses that can form a great foundation for a beginner yoga practice:

1. Mountain Pose (Tadasana)


Why it’s good for beginners: Mountain pose forms the basis for all standing poses. It grounds your feet into the mat. While activating your feet and legs and connecting with the earth underneath you, it draws your attention to lengthening the spine and opening the shoulders, helping Excellerate your posture.

How to do it: Stand on your mat with your feet hip-width apart. Allow your feet to feel grounded in the mat as you lengthen your spine and stand tall with arms by your sides.

2 . Downward Dog (Adho Mukha Shvanasana)


Why it’s good for beginners: This pose strengthens and stretches multiple muscles. It strengthens the arms, releases tension in the neck and low back, and stretches and lengthens the hamstrings and calves. Learning how to do a proper downward dog is important, as you will find this pose in most yoga classes.

How to do it: Begin on your hands and knees with your hands shoulder-width apart and fingers spread and your toes tucked under. Press your hands into the mat, inhale and lift your hips into the air, reaching your sit bones up and back toward the ceiling while lengthening your arms, pushing the floor away through your shoulders and sinking your heels towards the ground.

3. Child’s Pose (Balasana)


Why it’s good for beginners: Child’s pose is a great resting pose for all levels. It’s a great position for resting, breathing and feeling grounded on the floor. It’s also a great way to help release your hips and lower back, as well as reduce anxiety.

How to do it: Sit on your shins with your hips resting on your feet. Fold forward, rounding your lower back and reaching your hands in front of you so your arms are outstretched forward, resting on the ground. Release your head so it rests on the ground or a blanket or pillow as you breathe gently into a deeper stretch.

4. Corpse Pose (Savasana)


Why it’s good for beginners: Corpse pose involves lying on your back in stillness. For many, it’s one of the hardest poses. While it’s challenging for some to be still and relax, it’s one of the most important things to be able to do in yoga.

How to do it: Lie on the floor with your arms straight by your sides, your palms facing up and your eyes shut. Position your feet about hip-width apart and lengthen your spine from neck to tailbone, stretching your legs away from you as you let your head and body sink into the earth. Soften the muscles in your face, release your jaw and tongue, and allow your eyes to close or your gaze to soften. Inhale, then melt into the ground as you exhale. Relax. Allow the earth to hold you there.

5. Cobra (Bhujangasana)


Why it’s good for beginners: This pose stretches your shoulders, abdomen and chest while improving spinal mobility and strength. It can feel quite invigorating. It’s also a precursor to more advanced poses, such as backbends and bow pose. This is a great pose to reverse forward, rounded shoulder postures.

How to do it: Begin on your stomach. Place your palms on the floor. Press up to your hands, rolling your shoulder blades down and back, extending through your back while lengthening your neck. Lift your chest and turn your gaze upward while resting your weight on the tops of your feet.

Tue, 15 Aug 2023 20:45:00 -0500 en-US text/html
Killexams : Odds wane for people still missing after blaze

KIHEI, Hawaii — Hurricane-fueled flash floods and mudslides. Lava that creeps into neighborhoods. Fierce drought that materializes in a flash and lingers. Earthquakes. And now, deadly fires that burn block after historic block.

Hawaii is increasingly under siege from disasters, and what is escalating most is wildfire, according to an Associated Press analysis of Federal Emergency Management Agency records. That reality can clash with the vision of Hawaii as paradise. It is, in fact, one of the riskiest states in the country.

"Hawaii is at risk of the whole panoply of climate and geological disasters," said Debarati Guha-Sapir, director of the international disasters database kept at the Centre for Research on the Epidemiology of Disasters at the Catholic University of Louvain in Belgium. She listed storms, floods, earthquakes, tsunamis and volcanoes.

Hawaii has been in more danger lately. This month alone, the federal government declared six different fire disasters in Hawaii — the same number recorded in the state from 1953 to 2003.

Across the United States, the number of acres burned by wildfires about tripled from the 1980s to now, with a drier climate from global warming a factor, according to the federal government's National Climate Assessment and the National Interagency Fire Center. In Hawaii, the burned area increased more than five times from the 1980s to now, according to figures from the University of Hawaii Manoa.

From 1953 to 2003, Hawaii averaged one federally declared disaster of any type every two years, according to the analysis of FEMA records. But now it averages more than two a year, about a four-fold increase, the data analysis shows.

It's even worse for wildfires. Hawaii went from averaging one federally declared fire disaster every nine years or so to one a year on average since 2004.

The fires on Maui reminded Native Hawaiian Micah Kamohoali'i of the state's largest-ever wildfire, which burned through his family's Big Island home in 2021.

That blaze "gave us an awareness of how dry things can be," Kamohoali'i said.

Linda Hunt, who works at a horse stable in Waikoloa Village on the Big Island, had to evacuate in that fire. Given the abundance of dry grass on the islands from drought and worsening fires, Hunt said fire agencies need to "double or triple" spending on fire gear and personnel.

"They are stretched thin. They ran out of water on Maui and had to leave the truck," she said. "Money should be spent on prevention and preparedness."

FEMA assesses an overall risk index for each county in America and the risk index in Maui County is higher than nearly 88% of the counties in the nation.

The federal disaster agency considers that a "relatively moderate" risk.

Hawaii's Big Island has a risk index higher than 98% of U.S. counties.

A 2022 state emergency management report listed tsunamis, hurricanes, earthquakes, floods, health risks and cyber threats as high risk to people, but categorized wildfire as a "low" risk, along with drought, climate change and sea level rise.

Yet fire is the No. 1 cause of Hawaii's federally declared disasters, equaling the next three types of disaster combined: floods, severe storms and hurricanes. Hawaii by far has more federally declared fire disasters per square mile than any other state.

For most of the 20th century, Hawaii averaged about 5000 acres burned per year, but that's now up to 15,000 to 20,000 acres, said University of Hawaii Manoa fire scientist Clay Trauernicht.

"We've been getting these large events for the last 20 to 30 years," he said from Oahu.

What's happening is mostly because of changes in land use and the plants that catch fire, said Trauernicht. From the 1990s on, there has been a "big decline in plantation agriculture and a big decline in ranching," he said. Millions of acres of crops have been replaced with grasslands that burn easily and fast.

He called it "explosive fire behavior."

"This is much more a fuels problem," Trauernicht said. "Climate change is going to make this stuff harder."

Stanford University climate scientist Chris Field said "these grasses can just dry out in a few weeks and it doesn't take extreme conditions to make them flammable."

That's what happened this year. For the first four weeks of May, Maui County had absolutely no drought, according to the U.S. drought monitor. By July 11, 83% of Maui was either abnormally dry or in moderate or severe drought. Scientists call that a flash drought.

Flash droughts are becoming more common because of human-caused climate change, an April study said.

Another factor that made the fires worse was Hurricane Dora, 700 miles to the south, which helped create storm-like winds that fanned the flames and spread the fires. Experts said it shows that the "synergy" between wildfire and other weather extremes, like storms.

Stanford's Field and others said it's difficult to isolate the effects of climate change from other factors on Hawaii's increasing disasters, but weather catastrophes are increasing worldwide. The nation has experienced a jump in federally declared disasters, and Hawaii has been hit harder.

"Those are places of fantasy and nothing bad is supposed to happen there. You go there to escape reality, to leave pain behind, not face it head on," University of Albany emergency preparedness professor Jeannette Sutton said.

Sat, 19 Aug 2023 18:11:00 -0500 en text/html
Killexams : I Begged My Doctors To Figure Out What Was Wrong With Me. Instead, I Was Medically Gaslit.

My husband and I have a video call every Sunday with my mother-in-law, a doctor in New Delhi. The conversation is usually light, but one morning she wanted to discuss the more serious matter of my health. For more than a year, I’d talked about how I’d been struggling with a disabling chronic illness following an infection with COVID-19. She knew doctors across specialties and asked if she could share my lab results with a few of them for an informal opinion. I agreed, thinking that I had nothing to lose. Maybe they’d uncover some insight that others had missed.

A couple of weeks later, on a sunny morning in June 2021, my mother-in-law signed on to the video call with a huge smile. She’d heard from her doctor friends.

“Great news!” she said. “They looked at your labs and history. It turns out” — cue drumroll — “there’s nothing wrong with you! Focus on healthy eating, do yoga every day, and you’ll feel better soon.”

My heart dropped. After more than a year of talking about the symptoms that had left me unable to work ― and sometimes to get out of bed ― my own family didn’t believe I was sick? I didn’t want to offend her. I forced a tight smile, thanked her for trying, and then stayed silent. After the call ended, I began to cry ― incredulous that even she didn’t understand and ashamed for acting so upset.

I’ve had long COVID since March 2020. My illness has given me a firsthand look at the dismissal faced by patients, especially women, who have chronic illnesses. Doctors repeatedly doubted the reality of my symptoms, leaving me without medical care for more than a year. Sadly, I’m not alone in this experience.

In a recent study, patients with long COVID “described encountering medical professionals who dismissed their experience, leading to lengthy diagnostic odysseys and lack of treatment options.” They often characterised these interactions as “gaslighting,” the maddening feeling of stating an obvious truth and then being disbelieved.

Discrimination appears to drive these dynamics. The widespread dismissal of long COVID is a familiar story for many people with illnesses such as chronic pain and myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS. Patients often struggle for years to receive diagnoses and treatments. ME/CFS, a disease that’s similar to long COVID and can result from infections such as mononucleosis, has a particularly ugly history.

Courtesy of Julie Strack

The author and her husband, Jawahar Shah, in Cape Cod, Massachusetts, on their first wedding anniversary in June 2019. "This was me before I got COVID," she writes.

Many of those with severe ME/CFS have waited decades for doctors to take their symptoms seriously. Meanwhile, their lives have wasted away in darkened rooms, as the sickest patients are unable to leave their beds or care for basic needs — eating, showering, using the bathroom — without around-the-clock help. About 90% of all people with ME/CFS, the vast majority of whom are women, still haven’t been diagnosed. Long COVID echoes this tragedy, although patients with the disease have faced less neglect than those with ME/CFS.

Like many people with long COVID, my illness started with a “mild” case of COVID-19. It was the kind of infection that doctors said would “resolve in 7-10 days.” I got into bed and waited. However, as days turned into weeks, my symptoms weren’t getting better; they were merely changing. I no longer felt short of breath but began “having trouble looking at things,” as I said about my eyestrain and light sensitivity.

My main symptom, a crushing exhaustion, was growing worse. The feeling was unlike sleep deprivation or overwork. Rather, it was more akin to the aftermath of being hit in the head with a bat: constant headaches, unfocused eyes, pain caused by light and sound, and a sense that I needed to curl into a cocoon and wait for the sickness to pass. After about a month, I could barely get out of bed. I would lie in a dim room for interminable hours, looking out my window at a patch of sky.

I began to understand intuitively that my illness could be long-term. Once, I glanced at the background of my phone: a picture of my hike in Maine over the previous Labor Day, with jagged rocks and pine trees opening to reveal a vast blue ocean. Despair began to creep into my chest, as I realised I might never again walk through nature unencumbered by a failing body. I told everyone — my family, doctors — that I was afraid I wouldn’t get better. They said variations of “yes, I know you feel that way.”

After being seriously ill for about six weeks, I was desperate to talk to an expert who could explain what was happening to me. I found a primary care doctor and told her my story: I couldn’t get out of bed for more than 30 minutes without feeling physically crushed. I had trouble focusing my eyes. Exposure to normal light and sound would supply me terrible headaches and nausea, and would make me feel terribly sick.

She listened for a few minutes and then, with a half-smile, said my symptoms were caused by anxiety. I agreed that I was anxious, because I wasn’t recovering. But could anxiety cause an inability to focus my eyes? “Yes,” she said flatly with the same half-smile, like she was speaking to a stubborn child.

Five months later, I saw a neurologist. This time, after a series of tests, she said my symptoms were likely to be “a rational response to the trauma of the pandemic.” In other words, I was anxious or depressed.

Courtesy of Julie Strack

The author votes in the 2020 election on Halloween. "I had recently relapsed, and walking two blocks to drop off my absentee ballot was tiring," she writes.

Even my therapist didn’t believe I was sick for months, giving me terrible medical advice that I now think she wasn’t qualified to offer. She was convinced that my symptoms were caused by obsessive-compulsive disorder. According to her logic, I was obsessed with monitoring the way my body felt, and this caused me to believe, falsely, that I could barely get out of bed. She told me not to talk to doctors after my primary care provider said my symptoms were caused by anxiety. “Just try to pay less attention to your body, and live your life the best way you can,” she said.

As anyone who is familiar with long COVID or similar illnesses knows, my therapist’s advice to ignore my symptoms was bound to end in disaster. Treatment of long COVID as a psychological disorder is negligent and dangerous. Patients are prompted to “push through” their exhaustion, which can make their illnesses much worse.

Even without support, I managed my disease adequately for the next six months, improving enough to return to my full-time job. However, my health came crashing down with a crushing relapse in October 2020, following weeks of overwork and family stress. I became nearly bed-bound again.

I’ve since improved at a glacial speed, but more than two years later, I’m still sicker than I was before my crash. I spoke with my therapist shortly after it happened and said emphatically: “I am not anxious. My anxiety is well controlled. I just feel terrible.” She sighed, realising her mistake, and replied, “OK, yes, go see someone about it.” She didn’t take responsibility for her massive fuckup. She didn’t apologise. Soon afterward, I found a different therapist who believed I was sick.

Many experts think that skepticism around chronic illness is rooted in sexism, which has historically pervaded medicine. In an article for The New England Journal of Medicine, Dr. Steven Phillips and Michelle Williams wrote, “If the past is any guide, they [patients with long COVID] will be disbelieved, marginalised, and shunned by many members of the medical community.” The authors said that long COVID disproportionately affects women, which may exacerbate the disregard. “Our medical system has a long history of minimising women’s symptoms and dismissing or misdiagnosing their conditions as psychological,” they wrote.

My experiences suggest that medical discrimination is, indeed, alive and well. Doctors concluded that my disease didn’t exist, presumably because they didn’t know how to diagnose or treat it. My gender likely made me even easier to dismiss, as women have long been labeled “hysterical.” When I face this kind of mistreatment, I sometimes feel that people’s prejudices are more important to them than my humanity.

Courtesy of Julie Strack

The author receives hyperbaric oxygen therapy, an experimental treatment for long COVID, in March 2023.

After more than a year without medical care, I finally saw two leading specialists in post-infection illness who diagnosed me with long COVID, along with a host of related conditions such as dysautonomia, small fibre neuropathy, mast cell activation syndrome and primary immunodeficiency.

Extensive lab tests, which were taken mostly after my mother-in-law’s attempt to find answers, showed that my immune system is dysregulated, meaning that I am both immunocompromised and have chronic inflammation that continuously injures my body. My nervous system is damaged, preventing my blood from circulating effectively and causing chronic low-level oxygen deprivation. There’s evidence that my body can’t extract oxygen efficiently from my blood vessels, and my mitochondria are damaged.

I eventually convinced my mother-in-law that my illness is real. She and I had an hourlong discussion about long COVID — the research, my lab tests — when she visited my husband and me last summer. This time, my arguments seemed to break through. My husband said she regrets the way she initially reacted and now wholeheartedly believes in the seriousness of my illness.

However, the battle for recognition of long COVID continues. I often see the disease being minimised or dismissed in the news and on social media. A recent Slate article proclaimed, “Long COVID is neither as common nor as severe as initially feared.” In an apparent rebuttal to such statements, Ed Yong said in an article for The Atlantic that “what was once outright denial of long COVID’s existence has morphed into [a conviction] ... that long COVID is less common and severe than it has been portrayed—a tragedy for a small group of very sick people, but not a cause for societal concern.”

Long COVID is far from rare, and it’s often serious. Research has found that 10% of those who first contracted COVID-19 amid the spread of the omicron variant had long COVID after six months, and about one-fourth of people with long COVID say they are significantly limited in their daily activities. People with commonly associated conditions, including dysautonomia and ME/CFS, are expected to experience lifelong symptoms. I’m among those patients, and I know others who are too.

Before my illness, I was an energetic person who could work in an office for 10 hours, go out for drinks in the evening, and then do it all again the next day. Now, my former commute might wipe me out by itself. I can work for five hours on a good day before I need to rest. (When I say “rest,” I mean “lie in a dark, silent room with my eyes closed.”) If I push past my exertion limits, or spend time in loud spaces, I become nauseated and unfocused, and I develop a painful headache.

Courtesy of Julie Strack

The author with her cats (from left) Tony, Gandalf and Star in December 2022. "Although my long COVID has improved somewhat over time, daily rest is still essential," she writes.

In May, I attended my sister’s graduation, a two-hour affair full of long speeches and animated screaming. I wore earplugs, but still left the event exhausted and in pain. I got into bed at 4 p.m., put on my eye mask, and didn’t emerge until the next day. My sister, who understands, let me leave without hesitation. I’m not always so lucky. When I tell friends that I need to rest or cancel plans, I often hear polite frustration in their voices.

Some communication gaps are understandable, as most people have never experienced anything like long COVID or similar diseases. The symptoms are mostly invisible to others, who only see that people like me often rest, if they see anything at all. Our society doesn’t have the language to explain these illnesses. Medical terms like “post-exertional malaise,” which refers to the crushing sickness and exhaustion that follows mental or physical exertion, sound more euphemistic than descriptive.

However, even if many people find it difficult to comprehend what long COVID and other chronic illnesses feel like, it shouldn’t be hard to understand that patients’ experiences are real. I’ve never had altitude sickness (a condition characterised by fatigue, headaches and nausea resulting from difficulty adjusting to high elevations), but I’ve never doubted that it exists or heard anyone else do so. That would be bizarre.

Similarly, people who are colourblind presumably accept the word of others who can perceive colours. Chronic illness is the same type of situation, except that it carries widespread stigma. As recently as last year, the disbelief was so profound that many doctors with long COVID were dismissed by their colleagues. Most of the clinicians who doubted my illness were women, suggesting that the sexism contributing to these biases is so ingrained that it often isn’t recognised.

Before I got sick, I had never experienced gaslighting on a wide scale. It was easy to tell myself that most people believed me because they knew I was credible. Now I realise that they were often biased in my favour. I showed people with privilege the world that they wanted to see: a place with few threats, where self-reliance and opportunity will always be available.

Julie Strack is a health communication specialist and writer based in New York City. She has presented original research on health inclusivity at the American Public Health Association’s annual meeting and published on patient-provider engagement in the journal PLOS ONE. Julie has been a patient with long COVID since March 2020. Reach her on Twitter via her account @juliestrack.

Tue, 15 Aug 2023 00:57:00 -0500 en text/html
Killexams : Drug treatment in Oregon still hitting a bottleneck at inpatient care

Amid a mounting crisis of substance use and overdoses in Oregon, millions more dollars every year are now flowing toward programs meant to help people kick their addictions and get back on their feet thanks to Measure 110. But an important link in the chain, inpatient drug withdrawal management, formerly known as detox, remains a bottleneck that this funding has thus far done little to ease.

Within the past year, KGW reporters have shadowed outreach workers as they attempted to make contact with people suffering from addiction on the streets, in Portland and beyond. But after making those contacts, workers are often confronted by another major challenge — trying to connect people with beds in an inpatient facility so that they can get through withdrawal, the brutal first step toward getting sober.

Inpatient withdrawal management is rarely, if ever, immediately available.

At Hooper Detoxification Stabilization Center in North Portland, inpatient admission opens for just an hour each weekday, from 6:45 to 7:45 a.m. At detox facilities like Hooper, people often line up at the door each morning for a chance at an open bed.

This is in Portland, where there are at least two such large-scale withdrawal management facilities, even if they're always operating at capacity. Other parts of Oregon aren't so lucky, which makes it much more difficult for outreach workers to get people into detox.

As of a March 2019 report — prior to Measure 110 — there were 13 withdrawal management facilities licensed with the Oregon Health Authority, for a total of 201 beds. Those facilities were located in just nine of Oregon's 36 counties.

According to OHA data obtained through a records request this month, there are now 22 withdrawal management facilities licensed with the state — although some are incredibly small and three even share a campus — with a total capacity of 308 beds. The facilities are now located in 14 counties.

It's a significant improvement. But it still isn't enough to keep up with the need.

Measure 110 and the detox deficit: What doesn't get funded and why

Before voters approved Measure 110 in the November 2020 election, proponents billed it as a way to expand and support drug treatment programs while working to eliminate the stigma and oft-lopsided criminal justice outcomes for members of marginalized groups.

From Oregon's cannabis taxes, Measure 110 reallocated about $300 million to support drug treatment programs, although the rollout saw major delays and most of that funding didn't truly get out the door until late 2022.

Setting aside the controversies around Measure 110's decriminalization of drugs in user quantities, critics have since pointed out another issue with the program — the fact that inpatient drug treatment in Oregon, including withdrawal management, doesn't seem to be benefiting directly from all of those millions of dollars.

The "why" of it seems to depend on who you ask.

For some, it's a fairly simple answer. In a June 2022 presentation shown to a Jackson County public safety coordinating council, the CEO of a southern Oregon drug treatment center outlined three things that she said are just flat-out ineligible for Measure 110 funding: medical withdrawal management, residential treatment and mental health services.

While it's difficult to pin down from the documentation surrounding Measure 110 why this would be the case — none of this is stated explicitly — one source explained on background that these three services are not considered "low-barrier" sources of treatment.

To explain this interpretation, it's necessary to dive into Measure 110 a little to explain that key term: low-barrier.

Nowhere in the original Measure 110 text, or in the amended version brought about by 2021's Senate Bill 755, are inpatient services even mentioned as distinct from outpatient services. The term that's used repeatedly is "low-barrier substance use disorder treatment."

Although the definition of that kind of treatment is a bit nebulous, the Oregon administrative rules adopted to govern Measure 110 provide a list of practices that this kind of treatment must meet to qualify for grant funding — services that are trauma-informed, have little in the way of wait times, and are provided regardless of criminal history, residency or ability to pay, among other requirements.

That's where the issue comes in for withdrawal management and these other services, to hear some providers tell it.

In order to qualify for services, people who show up for these kinds of treatment have to be evaluated on the seriousness of their needs according to a set of criteria established by the American Society of Addiction Medicine, which will determine whether or not they can access those services, one provider said. That's the first potential wrinkle — programs supported by Measure 110 grants are supposed to help anyone who walks in by figuring out their needs and setting them up with the right services.

The second problem is that withdrawal management, residential care and mental health treatment providers have limited capacity all throughout the state of Oregon, which means they often have waitlists. By Measure 110's standards, being made to wait for care is not low-barrier. The Measure 110 rules actually require that a patient receive treatment services within 48 hours of their initial assessment.

If this interpretation is correct, then Measure 110's rules and the current landscape of drug treatment pose something of a Catch 22. Sticking with withdrawal management as an example — there aren't enough treatment beds to meet the current need, creating waitlists and the need to triage patients. But if the waitlists and assessment criteria are part of the reason that detox programs can't benefit from Measure 110 funding, then they aren't any more likely to expand and meet the need.

More bang for the buck: A Measure 110 rebuttal

O'Nesha Cochran, a tri-chair for Measure 110's Oversight and Accountability Council, seemed willing to acknowledge the problem of having too little in the way of inpatient services, but completely disagreed with this understanding that medical withdrawal management, residential treatment and mental health services are simply ineligible for funding.

"This isn't true; we funded programs similar to this," she said in an email. "People with mental health and (substance use disorders) should be able to access low-barrier programs. So we wanted to inspire organizations to create low-barrier access. These people are already dealing with enough, why make it hard to get care?"

All of the drug treatment programs that Measure 110 funded have to do mental health assessments that use the aforementioned ASAM criteria, Cochran added, so this wouldn't be a reason in and of itself why a program wouldn't be considered low-barrier.

Cochran instead described the detox deficit as a multifaceted issue. First, inpatient drug treatment centers generally require a great deal of upfront costs in order to get set up and operating. They need qualified medical staff on-site and available 24/7. The Measure 110 grants, while generous compared to what existed before, aren't enough to bankroll a brand new withdrawal management center.

"It's mind-boggling to think about how much inpatient treatment costs," Cochran said. "So the reason why Measure 110 was created is like, people weren't being successful with that type of model. When people think of $300 million they say, 'Well (that's) a lot of money.' But not when you're splitting it with the entire state of Oregon."

The grants also don't work particularly well for day-to-day operations at an inpatient facility, according to Cochran. Because they are provided up-front, grants simply can't account for patients' different lengths of stay or any unexpected incidents that arise.

"Say somebody got bed bugs in the treatment place, then you've got to shut the whole treatment facility down and you've got to do hazmat services for bed bugs," Cochran said. "But you can't really write that into a grant for Measure 110 because ... how can you say, 'I know I might get bed bugs so I need to put $75,000 for an 18-month stay just in case I've got bed bugs.'"

Most organizations that are already up and running to provide inpatient withdrawal management bill those services to Medicaid, or the state's Oregon Health Plan, which reimburse the facility for the people they treat, as they treat them. Importantly, the Measure 110 grants can't be used to pay for anything that organizations already bill to insurance.

That caveat about insurance is another reason why there's been some confusion about whether Measure 110 can benefit things like inpatient treatment. While it's clear that the grants can't take the place of that insurance model, it's less clear from the documentation whether they can be used around it; helping inpatient providers with startup, expansion or to fill other gaps. Cochran said that Measure 110 has done just that, but not everyone is on the same page.

"What Measure 110 did ... it didn't not fund treatment beds. It funded organizations that already had the infrastructure to bill Medicaid, and they had treatment beds," Cochran explained. "But we had a few organizations that were super brand new, and they had these amazing ideals to have these treatment beds, but they didn't have the infrastructure to implement (them) at the rate that they're used."

Measure 110 also wasn't specifically tailored to boost inpatient services. Behavioral Health Resource Networks (BHRNs, pronounced like "burns"), what Measure 110 originally called Addiction Recovery Centers, are supposed to provide a broad spectrum of services rather than something specific, like inpatient withdrawal management or residential care. While BHRNs in more populous counties might be made up of multiple separate nonprofits that provide different services, rural counties are more likely to have just one or two trying to cover the spread.

And, as Cochran mentioned, making those services low-barrier was a high priority. According to her, the Measure 110 council set out with the intention that each of these BHRNS would include inpatient treatment. But it isn't something that the program required, and it isn't how things materialized.

How it has worked in practice is that most of the organizations funded by Measure 110 provide outreach, harm reduction supplies and outpatient services — meaning people in recovery can come in to receive medication-assisted treatment and support but aren't staying overnight — and help with transitional housing or employment, among other things. Inpatient treatment is rarely on the list, with some exceptions.

Cochran suggested that Measure 110 funding can go further by using a workaround. Some organizations are pairing outpatient drug treatment with transitional housing, something like a halfway house where people seeking services can still get a place to stay while working to kick their addiction.

"And it's cheaper because now all we have to pay for is the brick and mortar," Cochran said. "We're not talking about a treatment bed, so what we're encouraging individuals to do is get on (the Oregon Health Plan), take care of their own treatment needs to be self-sufficient in that way, go out and get jobs, they can have a peer recovery mentor, they can get outpatient treatment to get support to stay clean."

For Cochran, this is personal. After decades spent in and out of jail or prison, it wasn't inpatient treatment that helped her kick substance use — it was the place she now works, Miracles Club in Northeast Portland, and the peers she met there. Miracles Club is a recipient of Measure 110 grants, and she thinks those funds are being put to good use.

"I appreciate people saying we still need treatment beds, and Measure 110 did fund a lot, but we need to rethink how we're going to impact more treatment beds," Cochran added. "And maybe the solution to that is to support the infrastructure of the treatment beds that already exist."

The legislature successfully passed a bill this session, House Bill 2513, containing some modest reforms to Measure 110. The workgroup that developed the bill hoped to clarify some of the murky territory uncovered during the rollout, much of which arose from different interpretations of the law by both drug treatment providers and by members of the oversight council who decided which organizations would become grant recipients.

Included in the bill are some relatively subtle tweaks to Measure 110 in regards to the kinds of programs that are eligible for funding, but the bill is primarily a response to the results of a Secretary of State's office audit delivered earlier this year that found fault with how Measure 110's oversight council and the OHA collaborated in the early days of the rollout.

Under HB 2513, the OHA now has a larger role in administration of Measure 110, and more funding with which to do it — which could help eliminate some of the ambiguity around eligibility in future grants.

Beds in demand: Inside inpatient treatment

On an average morning, as people line up at the door of Hooper Detox in North Portland for a chance at a treatment bed, the facility is able to admit about 14. That's according to Dr. Amanda Risser, Central City Concern's senior medical director for substance use disorder services. It's a 60-bed facility, the largest of its kind in the state.

The patients who get in and secure a bed usually stay an average of five days, receiving medication to help ease withdrawal symptoms, plus round-the-clock monitoring and support. At the end of their stay, some of them are ushered on to either residential care or continuing outpatient treatment, if possible. Others simply go home, or go back to the street. It depends on what patients want and what services are available at the time.

But not everyone who shows up at Hooper on a given day will get a bed. People regularly do get turned away, although it's perhaps not as bad as it once was.

"Back in the day, when Hooper first opened, there were stories of people just showing up every day for seven days straight, trying to get into Hooper, and they'd have to just keep coming back," Risser said. "And that is not what we want. We know when people want treatment, the closer the period of time is between asking for and receiving treatment, (it) improves outcomes."

There is also a certain amount of triage that Hooper's staff must do for prospective patients. Some people, Risser acknowledged, just don't fit the ASAM criteria for this level of inpatient withdrawal management and are instead referred to other programs that might be a better fit.

Most days, at least some people who show up at Hooper for treatment are turned away just due to capacity limits, Risser said. Last year, Hooper admitted about 2,700 people and turned away 2,100. Things are looking up this year, she said — admissions are creeping over 3,000, with less than 2,000 people turned away.

While Risser is of the opinion that Hooper is a relatively low-barrier service, and Central City Concern as a whole provides a spectrum of services that is probably unparalleled in the state of Oregon, it's not entirely clear that the inpatient treatment center meets Measure 110's definition of low-barrier.

"A lot of the guiding principals around Measure 110's design were something like — somebody walks in the door, we have services to provide them no matter what they need at all times of the day," Risser said. 

Though Central City Concern strives to provide services that are easy for people to access, a priority they share with the designers of Measure 110, there are just some inherent limitations to inpatient care of the kind that Hooper offers.

"It's hard for me to imagine a one-stop shop where you could be admitted for withdrawal management and, you know, get admitted for a wide variety of services," she said. "I think we're pretty close, though, because we have such a broad spectrum of offerings at Central City Concern."

Central City decided against applying for Measure 110 funding for Hooper, Risser said, although they did apply on behalf of other programs and succeeded in getting grants.

"The easiest funds to access were starting things new and from scratch," she said. "So we'd love to renovate our building, we'd love to add a bunch of beds, and we evaluated whether Hooper would be an appropriate place to apply for Measure 110 funding and we decided not to — we decided what we would get was not worth the time and energy, and there were other ways to get our needs met in terms of funding."

And regardless, those Measure 110 funds are filling a need, Risser indicated. People usually show up to Hooper because they need that significant level of care. Many other people with substance use disorders, perhaps the majority, don't need inpatient withdrawal management and will be better served elsewhere.

But at the end of the day, Oregon is still suffering from a deficit of inpatient care, Risser underlined — and not just in withdrawal management.

"There's not enough capacity for treatment in our whole state," she said. "We need more programs that can admit our patients in a timely manner for outpatient treatment, we need more residential beds ... and we need a wider variety of beds, maybe that can meet the needs of people with disabilities, maybe folks with more serious mental health issues."

The need for these longer-term forms of residential care is growing, Risser said, because the behavioral health and medical care conditions that professionals are seeing these days are getting more complex and more pronounced. She attributed this to the COVID-19 pandemic, to the changing supply of street drugs and to the compounding effects of Oregon's ongoing lack of access to care.

"Measure 110 was part of the solution, and I'm really glad my patients have less criminal justice burden when they come into treatment, because that can be really disruptive," Risser said. "I think our workforce is really in crisis, and I think any effort we can make to make training lower-barrier for individuals, to make these jobs better compensated and more attractive ... things that people really want to do and want to do long-term I think would be really helpful. So I think money is a big part of that."

The problem of capacity at a facility like Hooper, for example, sometimes is just a matter of not having enough physical beds or space to treat more people. But at other times — perhaps more commonly at other facilities, Risser indicated — it's a matter of not having the necessary staff to care for more patients. That's a problem being felt across the behavioral health field.

And housing will need to be a big part of any solution, Risser added. Substance use can be a coping mechanism for people living on the streets, making it much more difficult for them to get or stay sober even if they want to get help.

Study and study again: Where the state fits in

State officials have known for years about Oregon's overall lack of capacity for drug treatment and "significant waiting lists" at withdrawal management facilities in particular. In 2017, the legislature passed Senate Bill 1041, which directed the Oregon Criminal Justice Commission to study the state's publicly-funded substance use treatment infrastructure. The commission delivered the resulting report in March 2019.

"While Oregon struggles with some of the highest substance abuse and mental health problems in the country, access to services ranks among the poorest of all states," the report states. "Oregon now ranks third nationally with the highest number of people needing but not receiving treatment for alcohol and substance use disorders."

That awareness hasn't gone away. In 2021, lawmakers allocated $1.35 billion for Oregon's behavioral health system, intended to be a "transformative" investment in those systems through 2023. Of those funds, $67 million was specifically earmarked for projects to increase the number of behavioral health beds in Oregon.

"We’re grateful for the legislature’s historic increase in behavioral health funding, which is helping to correct years of underinvestment," said Steve Allen, then-director of behavioral health at the Oregon Health Authority, in a statement accompanying a 2022 update. "We have more work to do, but we’re building a system that can address the full range of services people need to get in treatment, sustain their recovery and lead full and productive lives.”

During this year's legislative session, lawmakers approved another $164 million intended to expand Oregon's behavioral health offerings — although much of that funding is earmarked for specific initiatives, only some of it related to inpatient care.

Credit: Office of the Governor

But first, another study. The Oregon Health Authority announced July 5 that state health officials have launched a review of the state's residential mental health and substance use treatment capacity to identify gaps and guide those investments from the legislature.

"The study will inform the state’s five-year plan to expand behavioral health treatment and build a more accessible, effective and equitable system of care," OHA said in a statement.

A contracted consulting firm will look at the amount of treatment and residential care beds in Oregon and determine how many are needed, analyze how much money should go toward expansion versus sustaining what's already there and looking at outcomes of prior behavioral health investments.

OHA said that this assessment will build on yet another study, one completed in 2022 by the OHSU-PSU School of Public Health, which also looked at the "significant service gaps" in Oregon's behavioral health system.

"The data shows the state would need to double its services to adequately address the current health needs of Oregonians struggling with addiction and also highlights significant gaps in healthy equity, including access to services and availability of culturally relevant care," OHSU said in a September statement.

It's unclear when this new study will be completed so that funding can go out, but there can be little doubt that this funding is not enough to double Oregon's drug treatment services.

“We are moving urgently to complete this effort," said OHA Behavioral Health Director Ebony Clarke in a statement. "We must find effective solutions to expand treatment and put more people on the path to recovery.”

Editor's note: On August 18, a nonprofit called Recovery Works Northwest unveiled a new 16-bed detox facility in Southeast Portland, which they say is the first of its kind in the state to open with Measure 110 backing.

The Story airs at 6:30 p.m. every weekday on KGW. Got a question or comment for the team? Shoot an email to or call and leave a voicemail at 503-226-5090.

Tue, 15 Aug 2023 11:27:00 -0500 en-US text/html
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