npr--2020-02-11--In Colombia, Ex-FARC Rebels And War Victims Work Together At New Radio Stations

In Colombia , Ex-FARC Rebels And War Victims Work Together At New Radio Stations Wearing headphones and speaking into a microphone , Mónica Córdoba conducts an interview at a newly opened public radio station in the northern Colombian town of Ituango .
It 's her first formal job in radio , but she 's comfortable in the studio .
That 's because Córdoba spent years working for a clandestine radio station operated by the Marxist guerrilla group known as the Revolutionary Armed Forces of Colombia , or FARC .
Broadcasting from Andean Mountain hideouts , she and her five-person team @ @ @ @ @ @ @ even radio soap operas .
`` We gave the news a revolutionary twist , '' she recalls with a smile .
That station went off the air in 2016 , when the guerrillas agreed to disarm .
But during the peace negotiations , they insisted on expanding their presence in the Colombian media .
So the Colombian government agreed to set up 20 FM public radio stations in former conflict zones , to be run by war victims as well as former guerrillas — like Córdoba .
The stations , such as the @ @ @ @ @ @ @ in July , are designed to provide local news in remote areas where there is little newspaper , TV or radio coverage or access to the internet .
But they also aim to educate Colombians about the peace accords and promote reconciliation after a five-decade war that killed some 220,000 people .
`` Local radio stations open spaces for the community and allow them to know what is happening in their regions , '' said Juan Pablo Madrid , an analyst at the Bogotá-based Foundation for Press Freedom .
`` They can be @ @ @ @ @ @ @ stations are part of Colombia 's state-run National Radio network and much of the daily programming comes from headquarters in Bogotá , the capital .
But in Ituango , a remote town tucked in the Andes Mountains that was ravaged by the war , reporters often conduct interviews with former combatants and update listeners on the progress and setbacks of the peace accords .
`` We try to entertain but also to educate , '' says Wilson Cartagena , a professional journalist who serves as station manager .
`` That 's the role @ @ @ @ @ @ @ visit by NPR in January , one of the announcers , María Eugenia Durango , recalled that her family was forced to flee Ituango during the war , amid intense combat between the army and the guerrillas .
After returning to the town , she took a job at the station last year alongside Córdoba , the former rebel .
`` For me , to work with someone who used to be in the guerrillas is proof that Colombians can come together in spite of everything that has happened , '' Durango says @ @ @ @ @ @ @ she got into radio by accident .
She joined the FARC guerrillas at age 14 more out of boredom than revolutionary fervor : `` I did n't even know what 'FARC ' stood for , '' she says .
She was issued a rifle , but was soon assigned to Voz de la Resistencia , or Voice of the Resistance , the rebel radio station where she spent most of the next two decades .
The Colombian military often tried to bomb the station .
Córdoba and her fellow guerrilla DJs would retreat @ @ @ @ @ @ @ transmitter , antenna and gasoline generator .
They always managed to escape .
Córdoba says she survived the war `` without a scratch . ''
The two sides also battled over the airwaves , with Voice of the Resistance urging government troops to desert , and army radio stations encouraging guerrillas to turn themselves in .
`` It was a war of the microphones , '' said Manuel Bolívar , a former guerrilla DJ who worked alongside Córdoba .
`` They would say on the air : 'Manuel , come over to our @ @ @ @ @ @ @ as a press officer for the FARC 's newly founded left-wing political party , while Córdoba is getting used to reporting news instead of rebel propaganda .
`` The news has to be impartial , '' Córdoba says .
`` You ca n't take sides . ''
Some Ituango residents , like furniture salesman Adolfo Trujillo , welcome the presence of former rebels on the radio .
Because many ex-FARC guerrillas grew up and lived in the countryside their whole lives , `` they know about the problems in rural areas , '' @ @ @ @ @ @ @ elements of Colombia 's peace accords , the public radio experiment has hit some snags .
So far , the government has built just two of the promised 20 stations .
Meanwhile , areas like Ituango are still plagued by violence because drug trafficking gangs have moved into areas once controlled by the guerrillas .
A day after NPR visited the town 's new public radio station , Durango , whose family had been uprooted by the fighting years ago , received a death threat from one of these gangs .
She no @ @ @ @ @ @ @ she had to flee Ituango for her safety .

In Colombia, Ex-FARC Rebels And War Victims Work Together At New Radio Stations
Enlarge this image toggle caption Joaquin Sarmiento/AFP via Getty Images Joaquin Sarmiento/AFP via Getty Images
Wearing headphones and speaking into a microphone, Mónica Córdoba conducts an interview at a newly opened public radio station in the northern Colombian town of Ituango. It's her first formal job in radio, but she's comfortable in the studio.
That's because Córdoba spent years working for a clandestine radio station operated by the Marxist guerrilla group known as the Revolutionary Armed Forces of Colombia, or FARC. Broadcasting from Andean Mountain hideouts, she and her five-person team produced news programs, rebel propaganda and even radio soap operas.
"We gave the news a revolutionary twist," she recalls with a smile.
That station went off the air in 2016, when the guerrillas agreed to disarm. But during the peace negotiations, they insisted on expanding their presence in the Colombian media. So the Colombian government agreed to set up 20 FM public radio stations in former conflict zones, to be run by war victims as well as former guerrillas — like Córdoba.
The stations, such as the one in Ituango, which began broadcasting in July, are designed to provide local news in remote areas where there is little newspaper, TV or radio coverage or access to the internet. But they also aim to educate Colombians about the peace accords and promote reconciliation after a five-decade war that killed some 220,000 people.
"Local radio stations open spaces for the community and allow them to know what is happening in their regions," said Juan Pablo Madrid, an analyst at the Bogotá-based Foundation for Press Freedom. "They can be fundamental in constructing peace."
The stations are part of Colombia's state-run National Radio network and much of the daily programming comes from headquarters in Bogotá, the capital. But in Ituango, a remote town tucked in the Andes Mountains that was ravaged by the war, reporters often conduct interviews with former combatants and update listeners on the progress and setbacks of the peace accords.
"We try to entertain but also to educate," says Wilson Cartagena, a professional journalist who serves as station manager. "That's the role of public radio."
During a visit by NPR in January, one of the announcers, María Eugenia Durango, recalled that her family was forced to flee Ituango during the war, amid intense combat between the army and the guerrillas. After returning to the town, she took a job at the station last year alongside Córdoba, the former rebel.
Enlarge this image toggle caption John Otis for NPR John Otis for NPR
"For me, to work with someone who used to be in the guerrillas is proof that Colombians can come together in spite of everything that has happened," Durango says.
For her part, Córdoba says she got into radio by accident. She joined the FARC guerrillas at age 14 more out of boredom than revolutionary fervor: "I didn't even know what 'FARC' stood for," she says.
She was issued a rifle, but was soon assigned to Voz de la Resistencia, or Voice of the Resistance, the rebel radio station where she spent most of the next two decades.
The Colombian military often tried to bomb the station. Córdoba and her fellow guerrilla DJs would retreat through the rugged Andes, lugging their transmitter, antenna and gasoline generator. They always managed to escape. Córdoba says she survived the war "without a scratch."
The two sides also battled over the airwaves, with Voice of the Resistance urging government troops to desert, and army radio stations encouraging guerrillas to turn themselves in.
"It was a war of the microphones," said Manuel Bolívar, a former guerrilla DJ who worked alongside Córdoba. "They would say on the air: 'Manuel, come over to our side!' "
Enlarge this image toggle caption John Otis for NPR John Otis for NPR
Bolívar now works as a press officer for the FARC's newly founded left-wing political party, while Córdoba is getting used to reporting news instead of rebel propaganda.
"The news has to be impartial," Córdoba says. "You can't take sides."
Some Ituango residents, like furniture salesman Adolfo Trujillo, welcome the presence of former rebels on the radio. Because many ex-FARC guerrillas grew up and lived in the countryside their whole lives, "they know about the problems in rural areas," he says.
Still, like many elements of Colombia's peace accords, the public radio experiment has hit some snags. So far, the government has built just two of the promised 20 stations.
Meanwhile, areas like Ituango are still plagued by violence because drug trafficking gangs have moved into areas once controlled by the guerrillas. A day after NPR visited the town's new public radio station, Durango, whose family had been uprooted by the fighting years ago, received a death threat from one of these gangs. She no longer works at the radio station because she had to flee Ituango for her safety.


npr--2020-02-11--Judge Rules In Favor Of T-Mobile Takeover Of Sprint

Judge Rules In Favor Of T-Mobile Takeover Of Sprint T-Mobile is closer to taking over Sprint after a federal judge rejected arguments by several states that the merger would stifle competition and lead to higher prices for consumers .
The deal would combine the country 's third- and fourth-largest wireless carriers .
The new company , to be called T-Mobile , would still be the third-largest , after AT & T and Verizon .
U.S. District Court Judge Victor Marrero concluded that the proposed merger `` is not reasonably likely to substantially lessen competition '' in the wireless market .
@ @ @ @ @ @ @ he was persuaded not to presume anticompetitive effects , as T-Mobile `` has redefined itself over the past decade as a maverick that has spurred the two largest players in its industry to make numerous pro-consumer changes . ''
He said that Sprint , meanwhile , `` is falling farther and farther short of the targets it must hit to remain relevant . ''
Marrero was not convinced that Sprint is likely to survive as a major competitor .
The case was brought by the attorneys general of New York , California , @ @ @ @ @ @ @ , Massachusetts , Michigan , Minnesota , Oregon , Pennsylvania , Wisconsin and the District of Columbia .
The Justice Department has already approved the deal , which was valued at $ 26.5 billion when the merger was announced in 2018 .
The merger remains subject to closing conditions and the possibility of further court proceedings .
New York Attorney General Letitia James said the states are considering an appeal .
`` From the start , this merger has been about massive corporate profits over all else , and despite the companies ' @ @ @ @ @ @ @ wireless subscribers where it hurts most : their wallets , '' James said in a statement .
`` There is no doubt that reducing the mobile market from four to three will be bad for consumers , bad for workers , and bad for innovation , which is why the states stepped up and led this lawsuit . ''
Part of the agreement is the combined company would help establish Dish Network as a fourth major wireless company .
Sprint 's prepaid customers would be moved to Dish , while most of Sprint @ @ @ @ @ @ @ T-Mobile .
Sprint and T-Mobile cheered Marrero 's ruling .
The companies say the merger would allow them to build a nationwide 5G network more quickly .
`` [ N ] ow we are FINALLY able to focus on the last steps to get this merger done ! ''
T-Mobile CEO John Legere said in a statement .
`` We want to thank the Court for its thorough review of the facts we presented in our case .
We 've said it all along : the New T-Mobile will be a supercharged Un-carrier @ @ @ @ @ @ @ for competition . ''
Shares of both Sprint and T-Mobile rose early Tuesday on news of the ruling .

Judge Rules In Favor Of T-Mobile Takeover Of Sprint
Enlarge this image toggle caption Bebeto Matthews/AP Bebeto Matthews/AP
T-Mobile is closer to taking over Sprint after a federal judge rejected arguments by several states that the merger would stifle competition and lead to higher prices for consumers.
The deal would combine the country's third- and fourth-largest wireless carriers. The new company, to be called T-Mobile, would still be the third-largest, after AT&T and Verizon.
U.S. District Court Judge Victor Marrero concluded that the proposed merger "is not reasonably likely to substantially lessen competition" in the wireless market.
In his ruling Tuesday, Marrero said he was persuaded not to presume anticompetitive effects, as T-Mobile "has redefined itself over the past decade as a maverick that has spurred the two largest players in its industry to make numerous pro-consumer changes." He said that Sprint, meanwhile, "is falling farther and farther short of the targets it must hit to remain relevant." Marrero was not convinced that Sprint is likely to survive as a major competitor.
The case was brought by the attorneys general of New York, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Oregon, Pennsylvania, Wisconsin and the District of Columbia.
The Justice Department has already approved the deal, which was valued at $26.5 billion when the merger was announced in 2018. The merger remains subject to closing conditions and the possibility of further court proceedings.
New York Attorney General Letitia James said the states are considering an appeal.
"From the start, this merger has been about massive corporate profits over all else, and despite the companies' false claims, this deal will endanger wireless subscribers where it hurts most: their wallets," James said in a statement. "There is no doubt that reducing the mobile market from four to three will be bad for consumers, bad for workers, and bad for innovation, which is why the states stepped up and led this lawsuit."
Part of the agreement is the combined company would help establish Dish Network as a fourth major wireless company. Sprint's prepaid customers would be moved to Dish, while most of Sprint's other customers would have plans through T-Mobile.
Sprint and T-Mobile cheered Marrero's ruling. The companies say the merger would allow them to build a nationwide 5G network more quickly.
"[N]ow we are FINALLY able to focus on the last steps to get this merger done!" T-Mobile CEO John Legere said in a statement. "We want to thank the Court for its thorough review of the facts we presented in our case. We've said it all along: the New T-Mobile will be a supercharged Un-carrier that is great for consumers and great for competition."
Shares of both Sprint and T-Mobile rose early Tuesday on news of the ruling.


npr--2020-02-12--The Hope And Hype Of Diabetic Alert Dogs

The Hope And Hype Of Diabetic Alert Dogs It 's a few minutes before services on a Sunday morning at Bethany United Methodist Church in West Jefferson , N.C .
The handbell choir warms up and an acolyte lights candles .
Church member Peggy Lynn Gibson walks in with her dog , a stout , cream-colored golden retriever named Rocky .
The congregants greet Rocky like an old friend .
`` How are you ?
You 're a sweetheart , '' one man says to the dog .
`` And so are you , '' the man tells Gibson .
@ @ @ @ @ @ @ Rocky , an honorary church member , settles in at Gibson 's feet in a pew near the back .
`` We love Rocky , right ?
And we love Peggy , '' Money says from the pulpit on the day NPR visited .
Gibson , a 67-year-old retired nurse , is one of more than a million Americans with Type 1 diabetes , a difficult-to-manage autoimmune disease .
People with the disease face a constant struggle to control the amount of sugar in their bloodstream .
If it gets too low , @ @ @ @ @ @ @ of consciousness , or death .
And Rocky was there to help .
He 's a diabetic alert dog specially trained to smell dangerous changes in someone 's blood sugar and alert them with a paw or a nudge before it becomes a medical emergency , and he was a gift from the church community .
A chili lunch , a silent auction , even a concert by local musicians all helped with his $ 15,000 price tag .
Back at her home just outside West Jefferson 's picture postcard downtown , Gibson @ @ @ @ @ @ @ .
`` In these senior years , it became harder to recognize whether my blood sugar was going too high or whether it was going too low .
That was partly what prompted me to look into getting a diabetic alert service dog , '' she says .
But while Gibson obviously loves Rocky , he does n't provide the service she and her neighbors paid for .
Unfortunately , that may be par for the course .
The diabetic alert dog industry is unstandardized and largely unregulated .
And the science on @ @ @ @ @ @ @ out blood sugar changes is , at best , inconclusive .
Gibson says she was influenced by the online marketing campaign of Diabetic Alert Dogs of America , the Nevada company that sold Rocky .
`` They have their stories on there about the dogs they 've trained and the people they 've placed them with .
And , you know , it [ seemed ] sound to me , '' Gibson says .
If you research diabetic alert dogs , you 'll find a lot of hope for their role in managing @ @ @ @ @ @ @ find a fair amount of hype .
Television news stories about the dogs often uncritically accept their abilities , using words like `` incredible '' and `` amazing . ''
In fundraising campaigns , would-be alert dog owners position them as critical solutions to their disease .
NPR reviewed nearly 500 active GoFundMe campaigns that mention `` diabetic alert dog . ''
More than a third used phrases like `` lifesaver '' or `` lifesaving . ''
Dog training companies make similar claims .
Several of them have faced lawsuits or complaints recently @ @ @ @ @ @ @ that they say do n't work .
In Texas , a group of more than a dozen dog buyers sued a trainer for fraud and won a judgment for $ 800,000 .
In Virginia , the attorney general sued a service dog vendor after customer complaints about its dogs , which were marketed as `` backed by science '' and `` 100 percent effective . ''
The Virginia attorney general claimed that the company , Service Dogs By Warren Retrievers , deceived consumers about the animals ' abilities and cost , in many @ @ @ @ @ @ @ pet . ''
Company lawyer Glen Franklin Koontz tells NPR his client denies the allegations and calls the lawsuit `` baseless . ''
He stands by the `` backed by science '' claim and adds : `` A fully trained dog is 100 percent effective . ''
The reason it might take a lawsuit to fight back against perceived or actual shortcomings in an alert dog is that trainers and dogs generally are n't required by any authority or regulator to perform to any particular standards .
While Rocky was marketed as a @ @ @ @ @ @ @ certification came only from the company that sold the dog .
Soon after Gibson got Rocky , it was clear to her that he was n't cut out to be a service dog in public , especially in the windy high country of North Carolina .
Gibson says Rocky is easily frightened by common noises such as umbrellas opening and motorcycles passing , and ca n't work as an alert dog while he 's scared .
`` The first day that I had him out on my own , the wind blew up @ @ @ @ @ @ @ could n't run fast enough to try to hide , '' Gibson says .
`` It was just pure fear . ''
That was in April 2017 , right after she had to sign a series of disclaimers as a condition of getting the dog .
One document said Rocky `` met her expectations as a diabetic alert dog , '' even though she had only two days ' experience with him .
Another document said Rocky has a `` free will '' and was n't guaranteed to do what Gibson and her @ @ @ @ @ @ @ her to blood sugar changes .
`` I answered everything because I was so excited that he was there and I was positive , '' Gibson says .
`` I was hoping everything was going to be wonderful and then after the dust settled , everything was n't wonderful . ''
One paper she signed said Rocky was n't guaranteed to `` perform any specific action at any specific time . ''
The sweeping disclaimer might sound at odds with an expensive purchase that people trust with their lives .
But research on @ @ @ @ @ @ @ a reality check about the abilities of diabetic alert dogs in general .
What the science says University of Virginia psychologist Linda Gonder-Frederick tracked the performance of 14 diabetic alert dogs in a 2017 study .
Before the study , their owners believed the dogs would prove more accurate than their glucose monitor devices .
That did n't happen .
`` Overall , they really were not that reliable or accurate , '' she says .
Of 14 dogs in the study , only three performed better than statistical chance .
That 's @ @ @ @ @ @ @ in 2016 .
The dogs in that study detected low blood sugar events 36 % of the time .
They also had false positives .
Only 12 % of the dogs ' alerts happened during actual low blood sugar events .
Gonder-Frederick says some dog owners overestimate their beloved dogs ' talents , perhaps as they would a favored grandchild .
`` People might notice and remember when the dog is accurate much more easily than they would notice or remember when the dog was not accurate , '' she says .
`` @ @ @ @ @ @ @ strongly in their dog , when in fact maybe the dog 's right half the time . ''
The psychological process at work , she says , is a kind of confirmation bias .
Her research also contradicted what some believe — or hope — is true : That the dogs can be a good safety net for those who worry about blood sugar dropping as they sleep .
Some parents have turned to the dogs to safeguard their children during the night .
`` The accuracy just plummeted during the night .
@ @ @ @ @ @ @ , a dog can not work 24/7 , '' Gonder-Frederick says .
There 's not too much other research , but what does exist is n't more encouraging .
A study published in 2015 and a 2019 British study did find good performance but involved possible conflicts of interest .
Both studies were co-written by the dogs ' trainers or suppliers .
Authors of both articles tell NPR the arrangements did not amount to conflicts and did n't bias the studies .
Edwin Peeples , who co-owns Diabetic Alert Dogs of America , @ @ @ @ @ @ @ and more than 9 out of 10 of his clients are satisfied .
He says issues like Gibson 's — where a dog ca n't perform well in public — represent the toughest part of training an alert dog , and that he does his best to train the dog to work in the owner 's environment .
And for dogs that do n't work out , Peeples says he has a training guarantee .
`` They can bring that dog to my doorstep right here in Las Vegas , '' Peeples says @ @ @ @ @ @ @ I will do my absolute best to try to fix it , and if I ca n't , you get a brand-new dog . ''
But Jessica Moye , an Ohio mom with Type 1 diabetes , had a long-running dispute with Peeples and now helps run a Facebook group dedicated to complaints about Peeples ' company .
She says the replacement dog guarantee can mean little when there 's a child involved .
`` The child bonds with the dog , and then they have to choose whether or not to send @ @ @ @ @ @ @ , looking for that lifesaving alert , '' Moye says .
`` Or if they just let their child go on with life with this dog , regardless of the fact that it is n't working for them . ''
Moye got her dog , Hachi , in 2016 and paid Peeples ' company $ 11,000 for him .
Hachi was supposed to paw her if her blood sugar was out of range .
`` Hachi was never a reliable alerter .
If I got into his face and asked for the paw @ @ @ @ @ @ @ his paw , '' Moye says .
`` But there was never any link to the scent of my breath and whether my blood sugar was high or whether my blood sugar was low . ''
When Peeples agreed to refund some of her money , it was conditioned on her signing a nondisclosure agreement barring her from discussing the company with others .
He says he required the agreement because he did n't want it publicly known that he was providing a refund .
She refused to sign , leaving several thousand @ @ @ @ @ @ @ through the Facebook group , Moye says she 's heard from dozens of Peeples ' clients .
Some have struggled with dogs that are too aggressive or have other problems .
Some are happy .
While researchers have found little evidence that dogs can reliably sniff out blood sugar changes , they have encountered a kind of paradox : People who get alert dogs tend to do better with their diabetes .
`` They may just be more engaged with their diabetes , '' says Gonder-Frederick , the researcher .
`` They may @ @ @ @ @ @ @ often than they used to .
The dog is sort of a pleasant reminder of diabetes . ''
Sitting at her kitchen table with Rocky at her feet , Gibson says the dog has helped her feel less alone with her disease .
That 's despite the fact that , she says , he does n't work well when he 's scared from a thunderstorm or some other noise , and does n't alert her to blood-sugar changes at the rate she says the vendor promised - 80 percent of the time .
@ @ @ @ @ @ @ trained to alert her by jumping on her , and she says he 's more than half her weight .
Still , Gibson says : `` There will be just times that he 'll come and put his head on my leg and just look up at me , — as if he understands in some way what I 'm going through .
He 's always there for me . ''
But , she says , `` I felt sorry that Rocky as an animal was chosen to do a job he was @ @ @ @ @ @ @ not fair to the animal .
Neither is it fair to me as the recipient of a $ 15,000 specially trained dog that is n't capable of doing his job . ''
She says she plans to try to retrain Rocky herself , and despite his `` guarantee , '' she has no plans to send him back .
Huo Jingnan and Cat Schuknecht contributed to this story .

The Hope And Hype Of Diabetic Alert Dogs
Enlarge this image toggle caption Mike Belleme for NPR Mike Belleme for NPR
It's a few minutes before services on a Sunday morning at Bethany United Methodist Church in West Jefferson, N.C. The handbell choir warms up and an acolyte lights candles.
Church member Peggy Lynn Gibson walks in with her dog, a stout, cream-colored golden retriever named Rocky. The congregants greet Rocky like an old friend.
"How are you? You're a sweetheart," one man says to the dog. "And so are you," the man tells Gibson.
Pastor Dan Money welcomes the congregation as Rocky, an honorary church member, settles in at Gibson's feet in a pew near the back.
"We love Rocky, right? And we love Peggy," Money says from the pulpit on the day NPR visited.
Gibson, a 67-year-old retired nurse, is one of more than a million Americans with Type 1 diabetes, a difficult-to-manage autoimmune disease. People with the disease face a constant struggle to control the amount of sugar in their bloodstream. If it gets too low, it can lead to seizures, loss of consciousness, or death.
And Rocky was there to help. He's a diabetic alert dog specially trained to smell dangerous changes in someone's blood sugar and alert them with a paw or a nudge before it becomes a medical emergency, and he was a gift from the church community. A chili lunch, a silent auction, even a concert by local musicians all helped with his $15,000 price tag.
Enlarge this image toggle caption Robert Benincasa/NPR Robert Benincasa/NPR
Back at her home just outside West Jefferson's picture postcard downtown, Gibson talked about why she sought canine help.
"In these senior years, it became harder to recognize whether my blood sugar was going too high or whether it was going too low. That was partly what prompted me to look into getting a diabetic alert service dog," she says.
But while Gibson obviously loves Rocky, he doesn't provide the service she and her neighbors paid for. Unfortunately, that may be par for the course. The diabetic alert dog industry is unstandardized and largely unregulated. And the science on a dog's ability to reliably sniff out blood sugar changes is, at best, inconclusive.
Hope and hype
Gibson says she was influenced by the online marketing campaign of Diabetic Alert Dogs of America, the Nevada company that sold Rocky.
"They have their stories on there about the dogs they've trained and the people they've placed them with. And, you know, it [seemed] sound to me," Gibson says.
If you research diabetic alert dogs, you'll find a lot of hope for their role in managing Type 1 diabetes. And you'll find a fair amount of hype.
Television news stories about the dogs often uncritically accept their abilities, using words like "incredible" and "amazing." In fundraising campaigns, would-be alert dog owners position them as critical solutions to their disease.
NPR reviewed nearly 500 active GoFundMe campaigns that mention "diabetic alert dog." More than a third used phrases like "lifesaver" or "lifesaving."
Enlarge this image toggle caption Joe Buglewicz for NPR Joe Buglewicz for NPR
Dog training companies make similar claims. Several of them have faced lawsuits or complaints recently from consumers who bought diabetic alert dogs that they say don't work.
In Texas, a group of more than a dozen dog buyers sued a trainer for fraud and won a judgment for $800,000. In Virginia, the attorney general sued a service dog vendor after customer complaints about its dogs, which were marketed as "backed by science" and "100 percent effective."
The Virginia attorney general claimed that the company, Service Dogs By Warren Retrievers, deceived consumers about the animals' abilities and cost, in many cases simply selling "a $25,000 pet." Company lawyer Glen Franklin Koontz tells NPR his client denies the allegations and calls the lawsuit "baseless." He stands by the "backed by science" claim and adds: "A fully trained dog is 100 percent effective."
The reason it might take a lawsuit to fight back against perceived or actual shortcomings in an alert dog is that trainers and dogs generally aren't required by any authority or regulator to perform to any particular standards.
While Rocky was marketed as a "certified" alert dog, the certification came only from the company that sold the dog. Soon after Gibson got Rocky, it was clear to her that he wasn't cut out to be a service dog in public, especially in the windy high country of North Carolina.
Gibson says Rocky is easily frightened by common noises such as umbrellas opening and motorcycles passing, and can't work as an alert dog while he's scared.
"The first day that I had him out on my own, the wind blew up. He got so scared that he couldn't run fast enough to try to hide," Gibson says. "It was just pure fear."
That was in April 2017, right after she had to sign a series of disclaimers as a condition of getting the dog. One document said Rocky "met her expectations as a diabetic alert dog," even though she had only two days' experience with him.
Another document said Rocky has a "free will" and wasn't guaranteed to do what Gibson and her community paid $15,000 for: alert her to blood sugar changes.
"I answered everything because I was so excited that he was there and I was positive," Gibson says. "I was hoping everything was going to be wonderful and then after the dust settled, everything wasn't wonderful."
One paper she signed said Rocky wasn't guaranteed to "perform any specific action at any specific time."
The sweeping disclaimer might sound at odds with an expensive purchase that people trust with their lives. But research on alert dogs suggests it might also be a reality check about the abilities of diabetic alert dogs in general.
What the science says
University of Virginia psychologist Linda Gonder-Frederick tracked the performance of 14 diabetic alert dogs in a 2017 study. Before the study, their owners believed the dogs would prove more accurate than their glucose monitor devices. That didn't happen.
"Overall, they really were not that reliable or accurate," she says.
Of 14 dogs in the study, only three performed better than statistical chance. That's similar to what an Oregon researcher reported in 2016. The dogs in that study detected low blood sugar events 36% of the time. They also had false positives. Only 12% of the dogs' alerts happened during actual low blood sugar events.
Enlarge this image toggle caption Joe Buglewicz for NPR Joe Buglewicz for NPR
Gonder-Frederick says some dog owners overestimate their beloved dogs' talents, perhaps as they would a favored grandchild.
"People might notice and remember when the dog is accurate much more easily than they would notice or remember when the dog was not accurate," she says. "You find a person who believes very strongly in their dog, when in fact maybe the dog's right half the time."
The psychological process at work, she says, is a kind of confirmation bias.
Her research also contradicted what some believe — or hope — is true: That the dogs can be a good safety net for those who worry about blood sugar dropping as they sleep. Some parents have turned to the dogs to safeguard their children during the night.
"The accuracy just plummeted during the night. Dogs have to sleep too. Obviously, a dog cannot work 24/7," Gonder-Frederick says.
There's not too much other research, but what does exist isn't more encouraging. A study published in 2015 and a 2019 British study did find good performance but involved possible conflicts of interest. Both studies were co-written by the dogs' trainers or suppliers. Authors of both articles tell NPR the arrangements did not amount to conflicts and didn't bias the studies.
A trainer's guarantee
Edwin Peeples, who co-owns Diabetic Alert Dogs of America, says he has trained nearly 700 dogs and more than 9 out of 10 of his clients are satisfied.
He says issues like Gibson's — where a dog can't perform well in public — represent the toughest part of training an alert dog, and that he does his best to train the dog to work in the owner's environment. And for dogs that don't work out, Peeples says he has a training guarantee.
"They can bring that dog to my doorstep right here in Las Vegas," Peeples says. "Our response will be: I will do my absolute best to try to fix it, and if I can't, you get a brand-new dog."
But Jessica Moye, an Ohio mom with Type 1 diabetes, had a long-running dispute with Peeples and now helps run a Facebook group dedicated to complaints about Peeples' company. She says the replacement dog guarantee can mean little when there's a child involved.
Enlarge this image toggle caption Maddie McGarvey for NPR Maddie McGarvey for NPR
"The child bonds with the dog, and then they have to choose whether or not to send the dog back and start over again, looking for that lifesaving alert," Moye says. "Or if they just let their child go on with life with this dog, regardless of the fact that it isn't working for them."
Moye got her dog, Hachi, in 2016 and paid Peeples' company $11,000 for him. Hachi was supposed to paw her if her blood sugar was out of range.
"Hachi was never a reliable alerter. If I got into his face and asked for the paw, sure, he would give me his paw," Moye says. "But there was never any link to the scent of my breath and whether my blood sugar was high or whether my blood sugar was low."
Enlarge this image toggle caption Maddie McGarvey for NPR Maddie McGarvey for NPR
When Peeples agreed to refund some of her money, it was conditioned on her signing a nondisclosure agreement barring her from discussing the company with others. He says he required the agreement because he didn't want it publicly known that he was providing a refund. She refused to sign, leaving several thousand dollars on the table.
Now, through the Facebook group, Moye says she's heard from dozens of Peeples' clients. Some have struggled with dogs that are too aggressive or have other problems. Some are happy.
A happy paradox
While researchers have found little evidence that dogs can reliably sniff out blood sugar changes, they have encountered a kind of paradox: People who get alert dogs tend to do better with their diabetes.
"They may just be more engaged with their diabetes," says Gonder-Frederick, the researcher. "They may be checking their blood glucose much more often than they used to. The dog is sort of a pleasant reminder of diabetes."
Enlarge this image toggle caption Maddie McGarvey for NPR Maddie McGarvey for NPR
Sitting at her kitchen table with Rocky at her feet, Gibson says the dog has helped her feel less alone with her disease.
That's despite the fact that, she says, he doesn't work well when he's scared from a thunderstorm or some other noise and doesn't alert her to blood sugar changes at the rate she says the vendor promised — 80% of the time. Also, she complains that he was trained to alert her by jumping on her, and she says he's more than half her weight.
Still, Gibson says: "There will be just times that he'll come and put his head on my leg and just look up at me — as if he understands in some way what I'm going through. He's always there for me."
But, she says, "I felt sorry that Rocky as an animal was chosen to do a job he wasn't equipped to do. That's not fair to the animal. Neither is it fair to me as the recipient of a $15,000 specially trained dog that isn't capable of doing his job."
She says she plans to try to retrain Rocky herself, and despite his "guarantee," she has no plans to send him back.
Huo Jingnan and Cat Schuknecht contributed to this story.


npr--2020-02-12--Coronavirus Casts A Pall Over Cruise Industry At Height Of Booking Season

Coronavirus Casts A Pall Over Cruise Industry At Height Of Booking Season The Diamond Princess cruise ship has become a symbol of a global health nightmare .
To date , 135 cases of the coronavirus — the infectious disease the World Health Organization is now calling COVID-19 — have been confirmed aboard the ship .
David Abel is one of the remaining 3,600 people on board , quarantined in waters off the coast of Japan until at least Feb. 19 .
He 's been documenting life in quarantine : Medical staff doing checkups through the night , small boats ferrying @ @ @ @ @ @ @ told Britain 's Channel 4 News : `` 24/7 , we are not allowed to open the door until there is a knock on the door and they bring the food to us .
Other than that , we are like prisoners . ''
Keeping the spread of the virus contained in those close quarters is not only a big medical and logistical challenge , it could also take a big bite out of the cruise line business this year .
`` Ugh , everything 's down , '' laments Monish Luthra , @ @ @ @ @ @ @ a Miami software company that handles bookings for cruise companies .
About 10 days ago , he says , reservations started to plummet , starting with flight bookings in Asia .
`` We 've seen about a 40 % drop '' in cruise bookings , Luthra says .
Luthra himself is scheduled to embark on a cruise out of Sydney in about a week .
Originally , he was supposed to fly through Hong Kong , but he rerouted to avoid that virus hot zone .
He says he still loves cruising , @ @ @ @ @ @ @ up with his two kids .
`` I would n't know how to explain it to my 6 year old or my 8 year old why they ca n't leave that room , '' he says .
China makes up a small , but growing segment of the $ 45 billion cruise industry , says Emily Flippen , a senior analyst with The Motley Fool .
`` This is a major setback , '' she says .
Meanwhile , another cruise liner , Holland America 's MS Westerdam , has been drifting around @ @ @ @ @ @ @ five different ports , despite the fact it has no confirmed cases of the virus .
But the outbreak is not a widespread problem that will affect the industry long term , says Brian Salerno , senior vice president of maritime policy of the Cruise Line Industry Association .
He says the industry was quick to take precautions , from screening anyone who 's sick , or denying entry to anyone who recently traveled to China , or who was in contact with someone there .
Plus , he argues , the ships @ @ @ @ @ @ @ on board .
`` When you take a cruise at a cruise ship , you 're traveling with your hospital in a sense , '' he says .
The cruise industry has shaken off worse crises , says Gene Sloan , a writer for The Points Guy , a travel website .
Remember the dramatic sinking of the Costa Concordia that killed 32 people ?
`` At the time , there was a lot of speculation this is gon na kill the cruise business , '' he says .
Every year brings a @ @ @ @ @ @ @ hurricanes , or loss of power .
Sloan says the cruise industry has grown through them all .
So this virus , too , shall pass .

Coronavirus Casts A Pall Over Cruise Industry At Height Of Booking Season
Enlarge this image toggle caption Carl Court/Getty Images Carl Court/Getty Images
Updated at 9:51 a.m. ET
The Diamond Princess cruise ship has become a symbol of a global health nightmare. To date, 175 cases of the coronavirus — the infectious disease the World Health Organization is now calling COVID-19 — have been confirmed aboard the ship.
David Abel is one of the remaining 3,600 people on board, quarantined in waters off the coast of Japan until at least Feb. 19. He's been documenting life in quarantine: Medical staff doing checkups through the night, small boats ferrying supplies of food and medicine.
Abel told Britain's Channel 4 News: "24/7, we are not allowed to open the door until there is a knock on the door and they bring the food to us. Other than that, we are like prisoners."
Keeping the spread of the virus contained in those close quarters is not only a big medical and logistical challenge, it could also take a big bite out of the cruise line business this year.
"Ugh, everything's down," laments Monish Luthra, president and CEO of Odysseus Solutions, a Miami software company that handles bookings for cruise companies.
About 10 days ago, he says, reservations started to plummet, starting with flight bookings in Asia. "We've seen about a 40% drop" in cruise bookings, Luthra says.
What's worse, it's peak booking season for cruise lines.
Luthra himself is scheduled to embark on a cruise out of Sydney in about a week. Originally, he was supposed to fly through Hong Kong, but he rerouted to avoid that virus hot zone. He says he still loves cruising, but can't imagine spending weeks holed up with his two kids.
"I wouldn't know how to explain it to my 6 year old or my 8 year old why they can't leave that room," he says.
China makes up a small, but growing segment of the $45 billion cruise industry, says Emily Flippen, a senior analyst with The Motley Fool. "This is a major setback," she says.
Meanwhile, another cruise liner, Holland America's MS Westerdam, has been drifting around Asia, having been denied entry at five different ports, despite the fact it has no confirmed cases of the virus. The ship is now sailing for Cambodia, where the cruise will end Thursday, Holland America said Wednesday.
Global Health What Life Is Like For 3,700 Cruise Ship Passengers Stuck In Coronavirus Quarantine What Life Is Like For 3,700 Cruise Ship Passengers Stuck In Coronavirus Quarantine Listen · 6:09 6:09
But the outbreak is not a widespread problem that will affect the industry long term, says Brian Salerno, senior vice president of maritime policy of the Cruise Line Industry Association.
He says the industry was quick to take precautions, from screening anyone who's sick, or denying entry to anyone who recently traveled to China, or who was in contact with someone there.
Plus, he argues, the ships themselves are safe because medical care is on board. "When you take a cruise at a cruise ship, you're traveling with your hospital in a sense," he says.
The cruise industry has shaken off worse crises, says Gene Sloan, a writer for The Points Guy, a travel website.
Remember the dramatic sinking of the Costa Concordia that killed 32 people? "At the time, there was a lot of speculation this is gonna kill the cruise business," he says.
Every year brings a new challenge: norovirus, Zika, hurricanes, or loss of power. Sloan says the cruise industry has grown through them all. So this virus, too, shall pass.


npr--2020-02-12--Beer Waste Saves Montana Town $1 Million On Water Treatment

As America 's craft beer industry continues to boom , the waste it generates can pose challenges for sewer systems .
But if it 's used in the right spot , in the right amount , it 's potentially beneficial and can actually save wastewater treatment plants money .
In Bozeman , Mont.
, the Water Reclamation Facility treats more than 6 million gallons of water every day from sinks , showers , toilets — really anything that goes down a drain .
That includes liquid waste from more than 10 breweries in this city of nearly 50,000 .
Because @ @ @ @ @ @ @ and sugar , brewery waste can throw off the microbes that wastewater plants rely on to remove nitrogen and phosphorus .
The two nutrients can cause algae blooms in rivers and kill off fish .
`` But if we can use [ brewery waste ] correctly and put it in the right spot , it 's very beneficial to the process , '' engineering consultant Coralynn Revis says .
Revis led a pilot project here last summer to try to do just that .
Bozeman worked with a local brewery to feed its @ @ @ @ @ @ @ bacteria at just the right time in just the right dosage .
`` This is super simplified , but like , if they 're eating their french fries , they need a little ketchup with it .
So to get the nitrate out , you dose a little carbon , and the bugs are happier , '' Revis explained .
She says it worked .
Revis and her team got the idea from a small town about 300 miles to the north near the Canadian border .
On a recent Friday night , @ @ @ @ @ @ @ in Havre , Mont.
, population 10,000 , is packed .
Three years ago , the town 's wastewater plant manager approached brewery owner Michael Garrity with the idea of using leftover barley from making beer to feed his microbes .
`` With my knowledge of brewing and fermentation , I said 'Why are n't we doing this ?
This sounds amazing , ' '' Garrity says .
If it worked , the little town could potentially avoid having to spend $ 1 million upgrading its wastewater plant to meet new , more @ @ @ @ @ @ @ , Drue Newfield , Havre 's wastewater plant manager , walks over to something that looks like a well .
`` This is where we apply it , '' Newfield says .
For the last three years , Newfield or one of his employees has been dumping one bucket of spent barley from Triple Dog Brewing into the water rushing below every morning .
`` The bacteria love it is what I 've found , and it just disappears by the end , '' Newfield says .
The team did a lot of @ @ @ @ @ @ @ Newfield says they eventually figured out how much spent barley to add and what conditions the bacteria needed to be happy .
Without the free spent barley , the wastewater treatment facility would have had to buy a chemical called alum to do the same thing .
`` We know the alum that we saved already is about $ 16,000 a year for sure .
But if that would n't have done it , that 's when an upgrade around the corner would have been , and then if we have to do @ @ @ @ @ @ @ run into the millions , '' Newfield says .
The Environmental Protection Agency noticed Havre 's innovative approach and gave it an honorable mention at the end of last year .
`` I did n't go into this for an award .
I went into it just because — what do you do to do the best job you can ? ''
Newfield says .
Newfield and Michael Garrity with Triple Dog say they think their partnership is a model that could be replicated elsewhere .
Several towns in Montana are interested in @ @ @ @ @ @ @ even got a call from a plant manager in Boston .
But it may not work everywhere .
While the Water Reclamation Facility in Bozeman found the chemistry worked , the logistics of transporting the liquid brewery waste there are too expensive for now .
If regulations get stricter , the plant may consider this approach in the future .

Beer Waste Helps Montana Town Save Money On Water Treatment
Enlarge this image toggle caption Rachel Cramer/Yellowstone Public Radio Rachel Cramer/Yellowstone Public Radio
As America's craft beer industry continues to boom, the waste it generates can pose challenges for sewer systems. But if it's used in the right spot, in the right amount, it's potentially beneficial and can actually save wastewater treatment plants money.
In Bozeman, Mont., the Water Reclamation Facility treats more than 6 million gallons of water every day from sinks, showers, toilets — really anything that goes down a drain. That includes liquid waste from more than 10 breweries in this city of nearly 50,000.
Because it's rich in yeast, hops and sugar, brewery waste can throw off the microbes that wastewater treatment plants rely on to remove nitrogen and phosphorus. The two nutrients can cause algae blooms in rivers and kill off fish.
"But if we can use [brewery waste] correctly and put it in the right spot, it's very beneficial to the process," engineering consultant Coralynn Revis says.
Revis led a pilot project here last summer to try to do just that. Bozeman worked with a local brewery to feed its beer waste to the treatment plant's bacteria at just the right time in just the right dosage.
"This is super-simplified, but like, if they're eating their french fries, they need a little ketchup with it. So to get the nitrate out, you dose a little carbon, and the bugs are happier," Revis explained.
She says it worked.
Revis and her team got the idea from a small town about 300 miles to the north near the border with Canada.
On a recent Friday night, the taproom at Triple Dog Brewing in Havre, Mont., population 10,000, is packed.
Three years ago, the town's wastewater plant manager approached brewery owner Michael Garrity with the idea of using leftover barley from making beer to feed his microbes.
"With my knowledge of brewing and fermentation, I said, 'Why aren't we doing this? This sounds amazing,'" Garrity says.
If it worked, the little town could potentially avoid having to spend $1 million upgrading its wastewater plant to meet new, more stringent clean water standards.
Enlarge this image toggle caption Rachel Cramer/Yellowstone Public Radio Rachel Cramer/Yellowstone Public Radio
Across town, Drue Newfield, Havre's wastewater plant manager, walks over to something that looks like a well.
"This is where we apply it," Newfield says.
For the last three years, Newfield or one of his employees has been dumping one bucket of spent barley from Triple Dog Brewing into the water rushing below every morning.
"The bacteria love it is what I've found, and it just disappears by the end," Newfield says.
The team did a lot of troubleshooting the first two years, but Newfield says they eventually figured out how much spent barley to add and what conditions the bacteria needed to be happy.
Without the free spent barley, the wastewater treatment facility would have had to buy a chemical called alum to do the same thing.
"We know the alum that we saved already is about $16,000 a year for sure. But if that wouldn't have done it, that's when an upgrade around the corner would have been, and then if we have to do an upgrade, there's where you run into the millions," Newfield says.
The Environmental Protection Agency noticed Havre's innovative approach and gave it an honorable mention at the end of last year.
"I didn't go into this for an award. I went into it just because — what do you do to do the best job you can?" Newfield says.
Newfield and Garrity, of Triple Dog, say they think their partnership is a model that could be replicated elsewhere. Several towns in Montana are interested in trying it, and Newfield says he even got a call from a plant manager in Boston.
But it may not work everywhere. While the Water Reclamation Facility in Bozeman found that the chemistry worked, the logistics of transporting the liquid brewery waste there are too expensive for now. If regulations get stricter, the plant may consider this approach in the future.


npr--2020-02-12--Baseball Makes An Early Pitch To Catch The Interest Of Black Players

Baseball Makes An Early Pitch To Catch The Interest Of Black Players February 2020 marks the 100th anniversary of the Negro Leagues , which once provided African-Americans the chance to play professional baseball before the game was integrated .
Now , a century later , African-American participation in baseball is lagging .
The number of black Major Leaguers is only 8.4 % , according to The Institute for Diversity and Ethics in Sports .
The decline in baseball participation begins long before adulthood , but there are efforts to change that .
On a recent Saturday about two dozen children @ @ @ @ @ @ @ gathered at a recreation center in Washington , D.C. , for a baseball clinic .
It 's run by Senatorsss Satchel Paige Little League , which takes its name from the famed Negro Leagues pitcher .
`` Baseball is a sport that you need to learn the fundamentals of early in life , '' Senatorsss Satchel Paige president Andre Lee .
`` So , 4-years-old is right about the time you need to learn the game of baseball , '' Lee says .
Seven-year-old C.J .
Coley and his two younger siblings took @ @ @ @ @ @ @ says he 's a fan of the Washington Nationals and he plays baseball because , `` I think it 's a good sport to get your muscles moving .
I play every single base . ''
The beginning of the decline C.J .
is one of few African-Americans at the clinic and says he wants to be a professional baseball player .
That pleases Antonio Scott , general manager of The D.C. Grays Cal Ripken Collegiate Baseball League .
He 's on a mission to keep kids from falling into what he calls @ @ @ @ @ @ @ a child 's life when they begin to lose interest in baseball — often between the ages of 10 and 14 .
`` At that point , baseball is not as attractive to them anymore because they 're not getting the proper coaching or training or off-season workouts that they should be getting that will keep them active and keep their minds engaged in baseball , '' Scott says .
Children are more likely to identify with a sport when they see people who look like them playing it .
And that 's @ @ @ @ @ @ @ with Major League Baseball 's Reviving Baseball in Inner Cities program .
Scott says they want older children from their youth academies to work with kids like C.J .
`` It 's not only about the baseball on the field side of it , it 's the off-field talks that they can have with those middle school , high school players , too , because they went through what these kids went through , '' Scott says .
Keeping kids engaged in baseball increases the chance of them playing the game later in @ @ @ @ @ @ @ vice president for baseball development with MLB .
But cost can be a barrier for some families .
MLB 's youth programs are free and , Reagins says , they provide access to high-level training and competition .
`` If the foundation is built correctly , our hope is that not only do these kids get a college education , but they will get to the major league level which will then affect the numbers that you see in terms of the African-American player at the major league level , '' Reagins says @ @ @ @ @ @ @ African-Americans made up 20 % of first round MLB draft picks between 2012-2018 and he 's pleased with that turnout .
The numbers are still low The number of African-American baseball players continues to decline as children transition from high school to college .
There are 10,500 collegiate baseball players currently at Division I schools but only 6 % are African-American , according to the NCAA .
Scholarships may be one reason for the low number , says Antonio Scott of the D.C. Grays .
A typical college can only offer about 12 @ @ @ @ @ @ @ Compare that to 85 football scholarships per Division I school .
`` Nine times out of 10 [ players are ] going to choose the scholarship that gives them more money or that can cover more expenses in school — their tuition , room and board , books and things like that , '' Scott says .
`` When in baseball , they may be only able to cover just their room and board , or just their tuition .
And then this player has to find money that they do n't have @ @ @ @ @ @ @ . ''
The money just is n't there in baseball the way it is in other college sports , Scott says .
For parents like Sandra Coley , C.J .
's mom , college is still too far in the future .
Coley says she just wants her kids to play the game and earn an appreciation for it .
`` I want them to be able to make an informed decision and I do n't believe that anyone can make an informed decision unless they have some type of information about what @ @ @ @ @ @ @ So , you ca n't say you hate baseball and you 've never tried it one bit , '' Coley says .

Baseball Makes An Early Pitch To Catch The Interest Of Black Players
Enlarge this image toggle caption Esther Ciammachilli/WAMU Esther Ciammachilli/WAMU
February 2020 marks the 100th anniversary of the Negro Leagues, which once provided African-Americans the chance to play professional baseball before the game was integrated.
Now, a century later, African-American participation in baseball is lagging. The number of black Major Leaguers is only 8.4%, according to The Institute for Diversity and Ethics in Sports.
The decline in baseball participation begins long before adulthood, but there are efforts to change that.
On a recent Saturday about two dozen children between the ages of 4 and 8 gathered at a recreation center in Washington, D.C., for a baseball clinic. It's run by Senators Satchel Paige Little League, which takes its name from the famed Negro Leagues pitcher.
"Baseball is a sport that you need to learn the fundamentals of early in life," Senators Satchel Paige president Andre Lee says. "So, 4-years-old is right about the time you need to learn the game of baseball."
Seven-year-old C.J. Coley and his two younger siblings took part in the clinic. C.J. says he's a fan of the Washington Nationals and he plays baseball because, "I think it's a good sport to get your muscles moving. I play every single base."
The beginning of the decline
C.J. is one of few African-Americans at the clinic and says he wants to be a professional baseball player.
Remembrances Negro Leagues' Mamie 'Peanut' Johnson Dies At Age 82 Negro Leagues' Mamie 'Peanut' Johnson Dies At Age 82 Listen · 1:50 1:50
That pleases Antonio Scott, general manager of The D.C. Grays Cal Ripken Collegiate Baseball League. He's on a mission to keep kids from falling into what he calls "the gap" a time in a child's life when they begin to lose interest in baseball — often between the ages of 10 and 14.
"At that point, baseball is not as attractive to them anymore because they're not getting the proper coaching or training or off-season workouts that they should be getting that will keep them active and keep their minds engaged in baseball," Scott says.
Children are more likely to identify with a sport when they see people who look like them playing it. And that's one reason why The D.C. Grays partnered with Major League Baseball's Reviving Baseball in Inner Cities program. Scott says they want older children from their youth academies to work with kids like C.J.
"It's not only about the baseball on the field side of it, it's the off-field talks that they can have with those middle school, high school players, too, because they went through what these kids went through," Scott says.
Enlarge this image toggle caption Esther Ciammachilli/WAMU Esther Ciammachilli/WAMU
Keeping kids engaged in baseball increases the chance of them playing the game later in life, says Tony Reagins, executive vice president for baseball development with MLB. But cost can be a barrier for some families. MLB's youth programs are free and, Reagins says, they provide access to high-level training and competition.
"If the foundation is built correctly, our hope is that not only do these kids get a college education, but they will get to the major league level which will then affect the numbers that you see in terms of the African-American player at the major league level," Reagins says.
Reagins is quick to tout that African-Americans made up 20% of first round MLB draft picks between 2012-2018 and he's pleased with that turnout.
The numbers are still low
The number of African-American baseball players continues to decline as children transition from high school to college. There are 10,500 collegiate baseball players currently at Division I schools but only 6% are African-American, according to the NCAA.
Scholarships may be one reason for the low number, says Antonio Scott of the D.C. Grays. A typical college can only offer about 12 baseball scholarships split among 27 players. Compare that to 85 football scholarships per Division I school.
"Nine times out of 10 [players are] going to choose the scholarship that gives them more money or that can cover more expenses in school — their tuition, room and board, books and things like that," Scott says. "When in baseball, they may be only able to cover just their room and board, or just their tuition. And then this player has to find money that they don't have to cover the rest of their expenses."
The money just isn't there in baseball the way it is in other college sports, Scott says.
For parents like Sandra Coley, C.J.'s mom, college is still too far in the future. Coley says she just wants her kids to play the game and earn an appreciation for it.
"I want them to be able to make an informed decision and I don't believe that anyone can make an informed decision unless they have some type of information about what they're making the decision on. So, you can't say you hate baseball and you've never tried it one bit," Coley says.


npr--2020-02-12--Doctors Push Back As Congress Takes Aim At Surprise Medical Bills

When Carol Pak-Teng , an emergency room doctor in New Jersey , hosted a fundraiser in December for Democratic freshman Rep. Tom Malinowski , her guests , mostly doctors , were pleased when she steered the conversation to surprise medical bills .
This was a chance to send a message to Washington that any surprise billing legislation should protect doctors ' incomes in their battle over payments with insurers .
Lawmakers are grappling over several approaches to curtail the practice that can leave patients on the hook for huge medical bills , even if they have insurance .
As Congress @ @ @ @ @ @ @ is evidence the doctors ' message has been received : The bills with the most momentum are making more and more concessions to physicians .
As surprise medical billing has emerged as a hot-button issue for voters , doctors , hospitals and insurers have been lobbying to protect their own bottom line .
All that lobbying meant nothing got passed last year .
Television and internet ads are the most visible manifestation of the battle .
But in taking their cause to politicians , doctors have waged an extraordinary on-the-ground stealth campaign to @ @ @ @ @ @ @ professional credentials give them a kind of gravitas compared with other lobbyists who are merely hired guns .
For patients , getting an unexpected bill for a treatment they thought was covered by insurance can be financially devastating .
Surprise bills are sometimes triggered when patients unwittingly see a doctor out of network .
Fixing this is ultimately a fight between doctors and insurers over rate-setting and reimbursement .
But as more patients balk at surprise bills , lawmakers are under pressure to protect patients .
In turn , powerful lobbying forces have @ @ @ @ @ @ @ do n't want to pay the price for a fix .
The main message physicians are using to bring lawmakers into their corner ?
`` We just want to be paid a fair amount for the services rendered , '' Pak-Teng says .
Her congressman Malinowski has not endorsed any surprise billing legislation .
In congressional testimony in July , he cited the `` extra $ 420 million '' in medical debt patients in New Jersey reckon with each year .
`` There are many things that Republicans and Democrats sincerely disagree about @ @ @ @ @ @ @ , `` I do n't think that this is one of them .
I do n't see any philosophical difference amongst us about whether people should be stuck with massive surprise medical bills . ''
Doctors say they are taking the brunt of the criticism for the burden of surprise billing .
Little has been as powerful in shaping surprise billing legislation as the clout of hospitals and their doctors , many of whom are , in fact , employed by private equity-backed companies and armed with years of experience shaping surprise billing @ @ @ @ @ @ @ are throwing in a lot of money , funneling millions to lawmakers ahead of the 2020 elections .
Four physician organizations that have heavily lobbied on surprise medical bills and have private equity ties — the American College of Emergency Physicians , Envision Healthcare , US Acute Care Solutions and U.S. Anesthesia Partners — gave roughly $ 1.1 million in 2019 to members of Congress , according to a Kaiser Health News analysis of Federal Election Commission records .
The biggest recipients , from all four PACS combined , were Reps. Donna Shalala @ @ @ @ @ @ @ D-Fla. , who each received $ 26,000 .
Sen. Thom Tillis , R-N.C. , took in $ 25,500 , Senate Majority Leader Mitch McConnell , R-Ky. , got $ 25,000 and Rep. Brett Guthrie , R-Ky. , received $ 22,500 .
Do n't see the graphic above ?
Click here .
That was in tandem with a ground game led by local doctors .
ER doctors , anesthesiologists , radiologists and other specialists who most often charge out-of-network prices – and also are among the highest-compensated practitioners — fanned out to shape legislation @ @ @ @ @ @ @ , and to voice their concern to lawmakers that insurance companies would have too much leverage to control their compensation .
`` We by necessity place a tremendous amount of trust in our physicians , '' says Zack Cooper , an assistant professor at Yale University who has extensively researched surprise medical bills .
`` Frankly , they have an easier time lobbying members [ of Congress ] than the folks who are affected by surprise billing . ''
Lawmakers in both parties appear unified on resolving the problem of surprise billing .
@ @ @ @ @ @ @ air blew out of legislative proposals on the table at year 's end , that is largely where the agreement ends .
Fixing the problem comes down to settling on a system for deciding how much to pay for a disputed bill .
One approach is to set up an outside arbitration process , in which doctors and insurance companies would negotiate payment — this is the model preferred by doctors , who contend it puts them on better footing against insurance companies .
Another option would be to resolve surprise billing disputes @ @ @ @ @ @ @ on the median in-network rate for the service , an approach known as benchmarking .
Large employers , labor unions and insurance companies prefer this , but doctors feel it gives insurers too much control over prices they would have to live with .
The failure to get legislation through Congress in 2019 set up a potentially explosive battle in an election year .
Republicans and Democrats who have vowed to do something about health care costs must reckon with powerful industry groups whose influence transcends party lines .
Meanwhile , physicians and @ @ @ @ @ @ @ and back home through in-person meetings and phone calls with lawmakers and congressional staff .
They 've hosted dinners and fundraisers and organized fly-ins to flood Capitol Hill with in-person meetings .
They 've even led tours of their emergency rooms .
Pak-Teng , is among them , coming to Washington this week along with other physicians to petition lawmakers .
She is employed by Envision , a physician staffing company backed by private equity firm KKR .
She 's also on the board of the American Academy of Emergency Medicine , a @ @ @ @ @ @ @ There is a lot of anti-physician rhetoric out there , '' says Pak-Teng , who is pushing her physician colleagues to be more active in shaping public policy by sharing stories about the reality of caring for patients .
The lobbying by hospitals and physicians trying to protect their reimbursements has divided key lawmakers , compounding disagreements among senior House Democrats over the policy details of a bill and turf wars in Congress .
Three House committees have now unveiled legislation to ban surprise medical bills , each with different details .
`` @ @ @ @ @ @ @ .
We are trying to stop bad legislation , '' says Anthony Cirillo , an emergency medicine physician who describes a `` bad '' bill as one that favors insurance companies over doctors .
Cirillo is also a lobbyist for US Acute Care Solutions , a physician staffing company backed by private equity firm Welsh , Carson , Anderson & Stowe .
WCAS , which manages $ 27 billion in assets and is focused on health care and technology investments , is based in New York City and co-founded US Acute Care Solutions @ @ @ @ @ @ @ Cirillo says he met with lawmakers and their aides about `` 10 to 12 times '' in Washington last year .
Financial disclosures show he spent $ 340,000 between July and September lobbying on surprise billing on behalf of US Acute Care Solutions .
USACS ' political committee also contributed $ 134,500 to lawmakers in 2019 , according to FEC records .
Before the private equity-fueled group Doctor Patient Unity started running ads warning of the dangers of government price controls as an argument against legislation , surprise billing legislation being drafted in @ @ @ @ @ @ @ care committees was already tilting to be more favorable to doctors .
`` People on the Hill are very sympathetic to hospitals and physicians because they 're actually providing the care itself , '' said one Democratic aide , speaking on the condition of anonymity to candidly describe sensitive political dynamics .
`` Nobody wants to defend the insurers . ''
In May , a House Energy and Commerce Committee draft proposal included no mention of an outside arbitration process .
The same was true for a bill the Senate Health , Education @ @ @ @ @ @ @ June .
Instead , under those proposals , surprise billing disputes would be resolved by insurance companies paying doctors based on similar rates in that area .
By mid-July , though — roughly a week before Doctor Patient Unity registered as a business in Virginia — the Energy and Commerce legislation was amended to allow doctors to appeal to an independent arbiter if the payment exceeds $ 1,250 .
The revision was pushed by two physicians on the committee — Democrat Raul Ruiz of California and Republican Larry Bucshon of Indiana — and @ @ @ @ @ @ @ Texas anesthesiologist , describes as a `` turning point '' in negotiations over the bill .
`` It 's all about fairness , '' says Zaafran , who works for private equity-backed U.S. Anesthesia Partners .
He has been involved for a decade in surprise billing fights in Texas , which enacted a new law with an arbitration process last year .
U.S. Anesthesia Partners gave $ 197,900 in campaign contributions to members of Congress last year .
Zaafran chaired another coalition of medical specialties , Physicians for Fair Coverage , in 2019 @ @ @ @ @ @ @ surprise billing approach modeled on a New York law under which insurers and providers rely on arbitration .
Under that process , if there is a payment dispute between doctors and insurers , the two sides submit a proposed dollar amount to an independent mediator , who then selects one .
In New York , the mediators were told to base their decisions on the 80th percentile of the prices set by the hospital or physician .
Research has suggested that the model is broadly making health care more expensive for state residents @ @ @ @ @ @ @ according to findings from the USC-Brookings Schaeffer Initiative for Health Policy .
Still , on Capitol Hill , doctors complained that many procedures would fail to cost enough to qualify for arbitration as proposed in the Energy and Commerce bill , bolstered by data ER doctors presented to lawmakers showing that prices largely fall below $ 1,250 .
`` It 's largely out of reach , '' says Laura Wooster , a lobbyist with the American College of Emergency Physicians , whose political action committee contributed $ 708,000 to lawmakers in 2019 .
@ @ @ @ @ @ @ , you just have one threshold .
It 's going to impact different specialties so differently . ''
By December , House Energy and Commerce Committee leaders and Sen. Lamar Alexander , a Republican who chairs the Senate HELP Committee , agreed to lower the arbitration threshold to $ 750 as part of a bipartisan agreement on a bill .
Notably , several hospital lobbying organizations , such as the American Hospital Association and the Greater New York Hospital Association — the latter a strong financial backer of Senate Minority Leader Chuck Schumer @ @ @ @ @ @ @ Pak-Teng and other physicians also say that arbitration threshold is still too high .
The House Education and Labor Committee has unveiled surprise billing legislation with a similar framework .
`` I 'm open to listening to all sides on this , '' Rep. Greg Walden of Oregon , the top Republican on the House Energy and Commerce Committee , said in an interview .
`` We want to make sure doctors are adequately compensated . ''
Walden had harsh words for private equity firms that have attacked the Energy and Commerce legislation @ @ @ @ @ @ @ ads , saying they were `` misleading and scaring people '' and just made lawmakers dig in deeper .
The ads prompted a bipartisan probe from Walden and committee Chairman Frank Pallone , D-N.J. , into how the companies have influenced surprise billing practices .
`` I 'm not trying to hurtle a rock at them , but they 've been throwing a few my way , '' he said .
Arvind Venkat , a Pittsburgh emergency physician employed by staffing company US Acute Care Solutions , traveled to Washington multiple times last @ @ @ @ @ @ @ Pennsylvania .
But he also made sure to bring up surprise bills on his home turf , giving his congressman , freshman Democrat Conor Lamb , a tour of the emergency room at Allegheny General Hospital last summer .
`` There are two issues here , '' says Venkat , who leads the Pennsylvania chapter of the American College of Emergency Physicians and has practiced at Allegheny General for 12 years .
`` Patients need to be protected , [ and ] we need to avoid anything that disrupts in-network relationships between insurers @ @ @ @ @ @ @ to have been heard : Legislation is likely to change further this year as the House Ways and Means Committee pushes an approach that is friendlier to hospitals and doctors .
It builds off a one-page document committee leaders issued Dec. 11 that blunted momentum for a bipartisan deal that was to be included in a December spending bill .
The latest proposal from the committee includes an arbitration process to resolve payment disputes , with no minimum dollar amount needed to trigger it , and does n't ban surprise billing from air @ @ @ @ @ @ @ another special-interest lobbying group .
The patient protections would not take effect until 2022 .
Richard Neal , a Massachusetts Democrat who chairs the committee , remains an ally of Massachusetts hospitals .
He released the brief December surprise billing document two days after the Massachusetts Medical Society and Massachusetts Hospital Association wrote a joint op-ed in the Boston Globe arguing that benchmarking physician payments — as the Senate HELP and Energy and Commerce deal would do — would wreck the state 's health care system .
`` The heavy hand of government @ @ @ @ @ @ @ health care marketplace and insurers would have no incentive to engage physicians in building robust health care networks .
The connected system of care we have all been working toward in Massachusetts would immediately become fragmented and disjointed , '' the two groups wrote in the Boston Globe .
`` They were n't asking for favorable treatment .
They were asking for fair treatment , and there 's a big difference , '' Neal said in an interview .
`` I do n't want to rule anything out , but I think that @ @ @ @ @ @ @ '' `` We need to get a little bit more balance , '' added Rep. Donna Shalala ( D-Fla. ) , who endorsed the Ways and Means legislation unveiled earlier this month .
Shalala has at least two hospitals in her Miami-area district that rely on private equity-supported physician staffing companies .
`` I 'm worried about the hospitals , '' she said .
`` And the providers obviously include the docs . ''
Kaiser Health News ( KHN ) is a nonprofit news service covering health issues .
It is an editorially @ @ @ @ @ @ @ that is not affiliated with Kaiser Permanente .

Doctors Push Back As Congress Takes Aim At Surprise Medical Bills
Enlarge this image toggle caption Hannah Norman/Kaiser Health News Hannah Norman/Kaiser Health News
When Carol Pak-Teng, an emergency room doctor in New Jersey, hosted a fundraiser in December for Democratic freshman Rep. Tom Malinowski, her guests, mostly doctors, were pleased when she steered the conversation to surprise medical bills.
This was a chance to send a message to Washington that any surprise billing legislation should protect doctors' incomes in their battle over payments with insurers. Lawmakers are grappling over several approaches to curtail the practice that can leave patients on the hook for huge medical bills, even if they have insurance.
As Congress begins its 2020 legislative session, there is evidence the doctors' message has been received: The bills with the most momentum are making more and more concessions to physicians.
As surprise medical billing has emerged as a hot-button issue for voters, doctors, hospitals and insurers have been lobbying to protect their own bottom line. All that lobbying meant nothing got passed last year.
Television and Internet ads are the most visible manifestation of the battle. But in taking their cause to politicians, doctors have waged an extraordinary on-the-ground stealth campaign to win over members of Congress. Their professional credentials give them a kind of gravitas compared with lobbyists who are merely hired guns.
For patients, getting an unexpected bill for a treatment they thought was covered by insurance can be financially devastating. Surprise bills are sometimes triggered when patients unwittingly see a doctor out of network.
Fixing this is ultimately a fight between doctors and insurers over rate-setting and reimbursement. But as more patients balk at surprise bills, lawmakers are under pressure to protect patients. In turn, powerful lobbying forces have activated to protect doctors and insurers who don't want to pay the price for a fix.
The main message physicians are using to bring lawmakers into their corner? "We just want to be paid a fair amount for the services rendered," Pak-Teng says.
Her congressman, Malinowski, has not endorsed any surprise billing legislation. In congressional testimony in July, he cited the "extra $420 million" in medical debt patients in New Jersey reckon with each year.
"There are many things that Republicans and Democrats sincerely disagree about in this body," he said. "I don't think that this is one of them. I don't see any philosophical difference amongst us about whether people should be stuck with massive surprise medical bills."
Doctors say they are taking the brunt of the criticism for the burden of surprise billing.
Little has been as powerful in shaping surprise billing legislation as the clout of hospitals and their doctors, many of whom are, in fact, employed by private equity-backed companies and armed with years of experience shaping surprise billing legislation at the state level.
They are throwing in a lot of money, funneling millions to lawmakers ahead of the 2020 elections. Four physician organizations that have heavily lobbied on surprise medical bills and have private equity ties — the American College of Emergency Physicians, Envision Healthcare, US Acute Care Solutions and US Anesthesia Partners — gave roughly $1.1 million in 2019 to members of Congress, according to a Kaiser Health News analysis of Federal Election Commission records.
The biggest recipients, from all four PACs combined, were Reps. Donna Shalala, D-Fla., and Stephanie Murphy, D-Fla., who each received $26,000. Sen. Thom Tillis, R-N.C., took in $25,500, Senate Majority Leader Mitch McConnell, R-Ky., got $25,000, and Rep. Brett Guthrie, R-Ky., received $22,500.
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That was in tandem with a ground game led by local doctors. ER doctors, anesthesiologists, radiologists and other specialists who most often charge out-of-network prices – and also are among the highest-compensated practitioners — fanned out to shape legislation in a way that maintains their pay and to voice their concern to lawmakers that insurance companies would have too much leverage to control their compensation.
"We by necessity place a tremendous amount of trust in our physicians," says Zack Cooper, an associate professor at Yale University who has extensively researched surprise medical bills. "Frankly, they have an easier time lobbying members [of Congress] than the folks who are affected by surprise billing."
Arguing over the fix
Lawmakers in both parties appear unified on resolving the problem of surprise billing. But as was clear when all the air blew out of legislative proposals on the table at year's end, that is largely where the agreement ends.
Fixing the problem comes down to settling on a system for deciding how much to pay for a disputed bill. One approach is to set up an outside arbitration process, in which doctors and insurance companies would negotiate payment — this is the model preferred by doctors, who contend it puts them on better footing against insurance companies. Another option would be to resolve surprise billing disputes by having insurance companies pay doctors based on the median in-network rate for the service, an approach known as benchmarking. Large employers, labor unions and insurance companies prefer this, but doctors feel it gives insurers too much control over prices they would have to live with.
The failure to get legislation through Congress in 2019 has set up a potentially explosive battle in an election year. Republicans and Democrats who have vowed to do something about health care costs must reckon with powerful industry groups whose influence transcends party lines. Meanwhile, physicians and hospitals have made their case in Washington and back home through in-person meetings and phone calls with lawmakers and congressional staff. They've hosted dinners and fundraisers and organized fly-ins to flood Capitol Hill with in-person meetings. They've even led tours of their emergency rooms.
Pak-Teng is among them, coming to Washington this week along with other physicians to petition lawmakers. She is employed by Envision, a physician staffing company backed by private equity firm KKR. She's also on the board of the American Academy of Emergency Medicine, a trade organization representing ER doctors.
"There is a lot of anti-physician rhetoric out there," says Pak-Teng, who is pushing her physician colleagues to be more active in shaping public policy by sharing stories about the reality of caring for patients.
The lobbying by hospitals and physicians trying to protect their reimbursements has divided key lawmakers, compounding disagreements among senior House Democrats over the policy details of a bill and turf wars in Congress. Three House committees have unveiled legislation to ban surprise medical bills, each with different details.
"We are not trying to stop legislation. We are trying to stop bad legislation," says Anthony Cirillo, an emergency medicine physician who describes a "bad" bill as one that favors insurance companies over doctors.
Cirillo is also a lobbyist for US Acute Care Solutions, a physician staffing company backed by private equity firm Welsh, Carson, Anderson & Stowe. WCAS, which manages $27 billion in assets and is focused on health care and technology investments, is based in New York City and co-founded US Acute Care Solutions in 2015.
In an interview, Cirillo says he met with lawmakers and their aides about "10 to 12 times" in Washington last year. Financial disclosures show he spent $340,000 between July and September lobbying on surprise billing on behalf of US Acute Care Solutions. USACS' political committee also contributed $134,500 to lawmakers in 2019, according to FEC records.
Tilt toward doctors
Even before the private equity-fueled group Doctor Patient Unity started running ads warning of the dangers of government price controls as an argument against legislation, surprise billing legislation being drafted in one of Congress' most powerful health care committees was already tilting to be more favorable to doctors.
"People on the Hill are very sympathetic to hospitals and physicians because they're actually providing the care itself," said one Democratic aide, speaking on the condition of anonymity to candidly describe sensitive political dynamics. "Nobody wants to defend the insurers."
In May, a House Energy and Commerce Committee draft proposal included no mention of an outside arbitration process. The same was true for a bill the Senate Health, Education, Labor and Pensions Committee approved in June. Instead, under those proposals, surprise billing disputes would be resolved by insurance companies paying doctors based on similar rates in that area.
By mid-July, though — roughly a week before Doctor Patient Unity registered as a business in Virginia — the House legislation was amended to allow doctors to appeal to an independent arbiter if the payment exceeds $1,250. The revision was pushed by two physicians on the committee — Democrat Raul Ruiz of California and Republican Larry Bucshon of Indiana — and was a moment Sherif Zaafran, a Texas anesthesiologist, describes as a "turning point" in negotiations over the bill.
"It's all about fairness," says Zaafran, who works for private equity-backed US Anesthesia Partners. He has been involved for a decade in surprise billing fights in Texas, which enacted a new law with an arbitration process last year. US Anesthesia Partners contributed $197,900 to members of Congress last year.
Zaafran chaired another coalition of medical specialties, Physicians for Fair Coverage, in 2019, and pressured Congress to pursue a surprise billing approach modeled on a New York law under which insurers and providers rely on arbitration. Under that process, if there is a payment dispute between doctors and insurers, the two sides submit a proposed dollar amount to an independent mediator, who then selects one.
In New York, the mediators were told to base their decisions on the 80th percentile of the prices set by the hospital or physician. Research has suggested that the model is broadly making health care more expensive for state residents because of higher payments to doctors, according to findings from the USC-Brookings Schaeffer Initiative for Health Policy.
Still, on Capitol Hill, doctors complained that many procedures would fail to cost enough to qualify for arbitration as proposed in the House bill, bolstered by data ER doctors presented to lawmakers showing that prices largely fall below $1,250.
"It's largely out of reach," says Laura Wooster, a lobbyist with the American College of Emergency Physicians, whose political action committee contributed $708,000 to lawmakers in 2019. "The problem with a threshold is you just have one threshold. It's going to impact different specialties so differently."
By December, House Energy and Commerce Committee leaders and Sen. Lamar Alexander, a Republican who chairs the Senate HELP Committee, agreed to lower the arbitration threshold to $750 as part of a bipartisan agreement on a bill. Notably, several hospital lobbying organizations — such as the American Hospital Association and the Greater New York Hospital Association, the latter a strong financial backer of Senate Minority Leader Chuck Schumer — refused to back the deal.
Pak-Teng and other physicians also say that arbitration threshold is still too high. The House Education and Labor Committee has unveiled surprise billing legislation with a similar framework.
"I'm open to listening to all sides on this," Rep. Greg Walden of Oregon, the top Republican on the House Energy and Commerce Committee, said in an interview. "We want to make sure doctors are adequately compensated."
Walden had harsh words for private equity firms that have attacked the House legislation in a series of TV and Internet ads, saying they were "misleading and scaring people" and just made lawmakers dig in deeper. The ads prompted a bipartisan probe from Walden and committee Chairman Frank Pallone, D-N.J., into how the companies have influenced surprise billing practices.
"I'm not trying to hurtle a rock at them, but they've been throwing a few my way," he said.
What's coming
Arvind Venkat, a Pittsburgh emergency physician employed by staffing company US Acute Care Solutions, traveled to Washington multiple times last year to meet with congressional offices representing Pennsylvania. But he also made sure to bring up surprise bills on his home turf, giving local congressman, freshman Democrat Conor Lamb, a tour of the emergency room at Allegheny General Hospital last summer.
"There are two issues here," says Venkat, who leads the Pennsylvania chapter of the American College of Emergency Physicians and has practiced at Allegheny General for 12 years. "Patients need to be protected, [and] we need to avoid anything that disrupts in-network relationships between insurers and clinicians."
The call seems to have been heard: Legislation is likely to change further this year as the House Ways and Means Committee pushes an approach that is friendlier to hospitals and doctors. It builds off a one-page document committee leaders issued Dec. 11 that blunted momentum for a bipartisan deal that was to be included in a December spending bill.
The latest proposal from the committee includes an arbitration process to resolve payment disputes, with no minimum-dollar amount needed to trigger it, and doesn't ban surprise billing from air ambulance companies — a win for yet another special-interest lobbying group. The patient protections would not take effect until 2022.
Richard Neal, a Massachusetts Democrat who chairs the committee, remains an ally of Massachusetts hospitals. He released the brief December surprise billing document two days after leaders of the Massachusetts Medical Society and the Massachusetts Health & Hospital Association wrote a joint op-ed in The Boston Globe arguing that benchmarking physician payments would wreck the state's health care system.
"The heavy hand of government would create an unfair imbalance in the health care marketplace and insurers would have no incentive to engage physicians in building robust health care networks. The connected system of care we have all been working toward in Massachusetts would immediately become fragmented and disjointed," the two groups wrote in The Boston Globe.
"They weren't asking for favorable treatment. They were asking for fair treatment, and there's a big difference," Neal said in an interview. "I don't want to rule anything out, but I think that the momentum right now is arbitration."
"We need to get a little bit more balance," added Shalala, who endorsed the Ways and Means legislation unveiled earlier this month.
Shalala has at least two hospitals in her Miami-area district that rely on private equity-supported physician staffing companies.
"I'm worried about the hospitals," she said. "And the providers obviously include the docs."
KHN reporter Victoria Knight contributed to this story.
Kaiser Health News (KHN) is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.