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4 posts from March 2018

03/27/2018

The Reverend Patricia Lyons Discusses the Administration's Proposed Protection of Religious Beliefs and Moral Convictions Rule: March 26th

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In January the Trump administration published a proposed DHHS rule titled, "Protecting Statutory Conscience Rights in Health Care, Delegations of Authority."  For decades the federal government, via several legislative amendments, has protected healthcare providers who object to performing, or object to assist in performing, certain medical procedures based on their freedom of conscience and religious exercise.  While these protections moreover concern abortion they have been gradually expanded to include, for example, refusal to participate in assisted suicide.  The proposed rule however vastly expands these protections.  The administration is proposing a regulatory rule that would allow all health care personnel (as well as hospitals, labs, insurance companies and others) to refuse to provide any medical care to any person by claiming conscience, moral or religious objection.  For example, a pediatrician could refuse to treat a child of gay parents or an emergency room nurse could deny providing a terminal patient end of life pain management.  The proposed would also allow the health care worker to refuse to refer a patient or identify anyone or organization that in turn could refer.  Critics of the proposed say the rule would effectively weaponize discrimination and professional medical associations have expressed concerns the rule would allow clinicians to violate their codes of medical ethics.  These criticisms aside what is the theological basis, if any, that would legitimately allow claiming religious or moral exercise in denying health care? 

During this 31 minute conversation the Reverend Patricia Lyons discusses, in sum, that while Christian theological teaching supports the rights of individuals (and their obligation) to follow their conscience, doing so should neither be without consequence as the proposed would allow nor should such protection be used to undermine justice in delivering healthcare without discrimination.  The proposed she Reverend Lyons argues is not workable since it negates the providers obligation in recognizing the inherent dignity of all, undermines their commitment to their profession, erodes the state's obligation in delivering healthcare without prejudice, and altogether is a failure in addressing the common good.     

The Reverend Patricia Lyons is Missioner for Evangelism an Community Engagement, the Episcopal Diocese of Washington, Church House, Mount St. Alban, in Washington, D.C.  She is also an Associate Priest at the Church of the LyonsEpiphany.  Rev. Lyons was for several years chaplain, teacher and JK-12 Director of Service Learning at St. Stephen's and St. Agnes (Episcopal) School in Alexandria, VA.  Reverend Lyons has also taught as an adjunct at the Virginia Theological Seminary.  Reverend Lyons is an honors graduate from Harvard College.  She holds a Master of Divinity degree from the Harvard Divinity School.  She received her doctorate from Virginia Theological Seminary.  Reverend Lyons has published numerous sermons, articles and book chapters on moral and spiritual development theory, as well as consulted for independent schools on moral formation and service learning programs. 

The proposed rule is at: https://www.federalregister.gov/documents/2018/01/26/2018-01226/protecting-statutory-conscience-rights-in-health-care-delegations-of-authority.  

If you're interested in a related essay on this topic, THCB recently posted my essay, "HHS Conscience Rule Would Grant Providers Sweeping Rights to Deny Care," it's at: http://thehealthcareblog.com/blog/2018/03/30/hhs-conscience-rule-would-grant-providers-sweeping-rights-to-deny-care/.

03/15/2018

Author Timothy Hoff Discusses His Latest Work: "Next In Line: Lowered Care Expectations in the Age of Retail - and Value Based Health" (March 14th)

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During this 29-minute interview, Professor Timothy Hoff discusses moreover what market factors explain or are driving the degradation of the therapeutic relationship between the physician and the patient, or what he terms the doctor-patient dyad, these include the "retailing" of medicine, whether "next in line" retail medicine, where we've traded relational trust for calculative trust, is economically rationale, the (negative) effect it is having on physicians and possible solutions to save the physician-patient relationship and raise care delivery expectations. 

Professor Timothy Hoff is Professor of Management, Healthcare Systems, and Health Policy in the D'Amore-McKim School of Business and School of Public Policy and Urban Affairs at Northeastern University.  He is also a Visiting Associate Fellow at Oxford University's Green-Templeton College and a Visiting Scholar at the Said Business School, Oxford University.  Prior to Hoffhis academic career, Dr. Hoff worked for a decade as a primary care practice administrator and as a healthcare consultant.  His research has been published in Pediatrics, Archives of Internal Medicine, Journal of Organizational Behavior, Academy of Management Perspectives, Health Affairs and The Milbank Quarterly.   His research has received rewards from the American Sociological Association, Academy of Management, and the Society for Applied Anthropology.  His previous work, Practice Under Pressure: Primary Care Physicians and Their Work in the 21st Century earned an Outstanding Academic Title award from Choice Magazine in 2010.  He is also co-editor of the 2016 reference volume on transformation in the health professions workforce, it's titled, The Healthcare Professional Workforce also published by Oxford University Press.  Professor Hoff received his undergraduate degree in business administration and his Ph.D. in Public Administration and Policy from the University of Albany.  

For information on Next In Line go to: https://global.oup.com/academic/product/next-in-line-9780190626341?cc=us&lang=en&.

 

03/11/2018

Author Jonathan Engel Discusses His Recent Work, "Unaffordable: American Healthcare From Johnson to Trump" (March 9th)

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During this 30-minute interview Professor Engel discusses moreover why, as he notes, US healthcare is "uniquely dysfunctional," and "laden with profit taking" largely due to induced demand, provides an overview of efforts to contain spending growth via HMOs both in the commercial and the Medicare market, the success of Medicaid HMOs, and discusses his disappointments with the Affordable Care Act (ACA) actually making healthcare more affordable.    

Jonthan Engel is Professor of Health Policy and Management at the Marxe School of Public and International Affairs at Baruch College, CUNY.  He has taught previously at Seton Hall University, Mailman School of Public Health at Columbia University and the School of Public Health at the University of Massachusetts.  He has been a consultant to the White House's President's EngelJonathan-2017.165tAdvisory Committee on Human Radiation Experiments, the lead author on multiple HIV needs assessments for the City of Newark and director of research at the Local Area Board for Health Planning for Essex and Union counties in New Jersey.  His published works include: Doctors and Reformers: Discussion and Debate of Health Policy 1025-1950; Poor People's Medicine: Medicaid and the US Charity Care Since 1965; The Epidemic: A History of AIDS; American Therapy: The Rise of Psychotherapy in the US; and, Fat Nation, forthcoming.   He is currently writing a book on Cold War science and policy in the US.  Professor Engel received his BA from Harvard, an MBA from the Yale School of Management and his PhD in the history of medicine from Yale.  

For more information on "Unaffordable" go to: https://uwpress.wisc.edu/books/5682.htm.

03/04/2018

Unpacking BPCI, CMS' New Bundled Payment Demonstration: An Interview with Dave Terry (February 28th)

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This past January 9th CMS announced Bundled Payment for Care Improvement (BPCI) Advanced.  This five-year Medicare bundled or episode-based payment demonstration, that begins this October 1st, will succeed the agency'a five-year BPCI demonstration that sunsets this September 30th.  BPCI Advanced, also voluntary, will be considerably less expansive than its predecessor in that, among other things, it will include just 32 clinical episodes (29 inpatient and three outpatient), and offer only a single, 90 day retrospective bundled payment under one risk track.

During this 28 minute interview Mr. Dave Terry briefly defines Archway's business model/s, posits what attributes describe successful bundled payment providers, summarizes the findings from a recent study, he coauthored, of BPCI reimbursed total hip arthroplasty surgeries, how CMS has improved bundled payments under BPCI Advanced, or moreover in financial benchmarking and in quality measurement, the legitimacy of criticisms regarding care fragmentation and competition with other pay for performance models and likely success of the demonstration.

Mr. Dave Terry is currently CEO of Archway Health.  Previously, at Partners Healthcare in Boston, Mr. Terry negotiated Terry  Daveglobal cap and pay for performance contracts with managed care plans.  Prior still at Harborside Healthcare, he led a home care agency that managed Medicare and commercial episodes of care within a single payment.  As a partner with The Chartis Group, Mr. Terry developed provider networks and risk sharing models for Medicare Accountable Care Organizations (ACOs).  Mr. Terry holds an MBA from the Harvard Business School and a BA from Columbia University.  He currently serves on the board of Bottom Line, a national educational non-profit, and is a past board member of the Harvard Business School Health Industry Alumni Association.

For information on BPCI Advanced to go: https://innovation.cms.gov/initiatives/bpci-advanced.