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06/19/2022

Upcoming Podcasts: "Toxic Debt" and Organ Donations (June 28th and 30th)

Later this month as follow-up to my March environmental racism STAT article, I'll speak with Prof. Josiah Rector regarding his recently published book, Toxic Debt, An Environmental Justice History of Detroit.   See: https://uncpress.org/book/9781469665764/toxic-debt/.

I'll also speak with Mr. Greg Segal, Co-Founder of Organize,  non-profit patient advocacy group dedicated to increasing the number of transplantable organs.  See: https://www.organize.org/about

06/09/2022

My Latest Climate and Health Essay, "FDA User Fee Legislation Needs to Mitigate the Pharmaceutical Industry's Carbon Pollution" (June 8th)

Yesterday, STAT published my latest climate and health related essay.  Here is the email text I forwarded to Senator Murray's staff director.  

This morning STAT published my latest, "FDA User Fee Legislation Needs to Mitigate the Pharmaceutical Industry's Carbon Pollution."   I'd appreciate your reading and distributing to your colleagues. 
This is my 11th or 12th related article published over the past few years.  Believe me, I take zero pleasure in drafting these - nor any of the numerous related HHS comment letters or any of the over 25 related podcast interviews.  Just so you're aware, I receive no compensation for this work.   
I hope you know the climate crisis reality continues to worsen, e.g., Nature Climate Change just published research showing atmospheric CO2 is now measured at 421 ppm (50% higher than pre-industrial era), the highest in human history or higher than any time in at least 4 million years.  Every week Kim Stanley Robinson's, "The Ministry for the Future," becomes less and less cli-fi.   As always, I am happy to discuss related policy reforms with the Chairwoman or your staff.
Thank you.
David Introcaso, Ph.D.          

 

06/08/2022

Alfred and Blair Sadler Discuss Their Just Published, "(P)Luck: Lessons We Learned For Improving Healthcare and the World" (June 7th)

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(P)Luck moreover details the nine year collaboration between identical twins, Dr. Alfred Sadler and Blair Sadler, an attorney, via their work at NIH,  Yale, the Robert Wood Johnson Foundation and the Hastings Center on Bioethics to advance national organ donation and transplantation policy, create the Physician Assistant profession, advance national emergency medical care and address related bioethical issues.   The work also provides insights regarding related challenges these fields face today and provides a list of lessons learned applicable to present day health care problems. 

During this 39 minute discussion, Dr. Sadler and Mr. Sadler begin by explaining the purpose of the work and how and why they chose to collaborate after completing medical and law school.   The conversation moves on to an overview of their collaborative efforts, they discuss challenges still facing organ donation and persisting ethical issues, for example, related to the ongoing pandemic and conclude with comments concerning a few of the 15 lessons learn they identify.              

Alfred Sadler, MD, ScD (Hon) FACP, is the Co-Founder of the Physician Assistant Program at Cal State University, Monterey FredPhoto Bay and is the President of the Cypress Foundation - dedicated to improving physician and PA workforce in the tri-county area where he lives.  He was trained in surgery at the Hospital of the University of Pennsylvania and in internal medicine at the Harvard Medical School and at Mass General Hospital  He practiced primary care in Monterey County for nearly forty years with an emphasis on underserved populations.  He is a a member of Alpha Omega Alpha and in 2018 was recognized as Physician of the Year by the Monterey County Medical Society.  He is a coauthor of The Physician Assistant: An Illustrated History

Blair Sadler, JD, is a Senior Fellow at the Institute for Healthcare Improvement and a member of the BlairPhoto
faculty at the University of San Diego's Rady School of Management.   A graduate of Amherst College and the University of Pennsylvania Law School, he was a law clerk for the Superior Court of Pennsylvania.  From 1980 to 2006, he was President and CEO of the Rady Children's Hospital in San Diego.  He has served on the board of the Hastings Center for 12 years and is a member of the board of Health Care without Harm, an environmental health advocacy organization.  He chairs the Board of Access Youth Academy in San Diego.

Information on their work is at: https://www.bookdepository.com/P-Luck-Alfred-Sadler/9781735873176?ref=grid-view&qid=1654425267966&sr=1-6.  

   

06/04/2022

Mr. Jim MacMillan Discusses Gun Violence Reporting (June 3rd)

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Listeners are certainly aware of never ending US gun violence.  For example, since 37, moreover 4th grade children, were shot with 19 killed in Uvalde, Texas on May 24th, there have subsequently been at least 14 subsequent mass shootings killing at least 10 and wounding another 61.   Over the past ten years, or since the Sandy Hook , there have been 950 subsequent school shootings.   Concerning federal policy, via the so called (Jay) Dickey amendment the Congress effectively banned the CDC from researching gun violence between 1996 and 2020.  Presently, it does not appear the Senate will act to pass substantive and widely popular policies designed to reduce gun violence.   As the British journalist, Dan Hodges, concluded in 2015, "in retrospect, Sandy Hook marked the end of the US gun control debate.  Once America decided killing children was bearable, it was over."

During this 36 minute conversation, Mr. MacMillan begins by providing an overview of the Center's mission and its work along with the Center's weekly newsletter, the roots of the problem, suicide reporting, his preliminary impressions regarding the Uvalde shooting, his related interaction/experience with the medical community, status regarding the Center's work informing policy reform and the specifics of his "better gun violence reporting" initiative.          

Mr. Jim MacMillan is the Founder and Director of the Philadelphia Center for Gun Violence and its parent organization, the Initiative for Better Gun Violence Reporting.  Previously, Mr. MacMillan was a Journalist in Residence at Swarthmore 1630105371322 College, a Fellow at the Philadelphia Social Innovations Lab at the U. of Penn and a Practitioner in Residence at the Institute for Global Leadership at Tufts University.  Mr. MacMillan was also an Ochberg Fellow with the Dart Center for Journalism and Trauma at Columbia University and a Knight Fellow in Medicine/Health Sciences Journalism with the Knight-Wallace Fellows at the U. of Michigan.  Previous faculty appointments include the U. of Missouri School of Journalism, Swarthmore College, NYU's Carter Journalism Institute and Klein College of Media and Communication at Temple University.  During his prior photo journalism career, Mr. MacMillian spent 17 years at the Philadelphia Daily News and with The Associated Press working in Boston and Baghdad during the war in Iraq.  His teams war reporting was awarded the Pulitzer Prize. 

Information on the Philadelphia Center for Gun Violence is at: https://www.pcgvr.org/.  

05/20/2022

Posted on the Podcast Blog: My Comments in Response to HHS's Environmental Justice Strategy RFI (May 20th)

Since listeners have encouraged me to post some of my non-published writings, please click on the "Blog" link just below the title banner, scroll down and you will see my comment letter in response to HHS's Request for Information (RFI) titled, "2022 HHS Environmental Justice Strategy and Implementation Plan Draft Outline."  At: https://www.govinfo.gov/content/pkg/FR-2022-04-08/pdf/2022-07514.pdf

Listeners will not be surprised my comments focus on the climate crisis, i.e., they reflect, in part, previous comments in my related March 28th STAT News article, again at: https://www.statnews.com/2022/03/28/hhss-failure-to-address-the-health-harms-of-climate-crisis-constitutes-environmental-and-institutional-racism/.  The comment letter, at 3,000 words, will also provide status of the National Academy of Medicine's healthcare industry decarbonization effort along with Congressional and White House efforts.  

Listeners are encouraged to submit comments in response to the RFI.  Comments were initially due May 19th, however, HHS extended the deadline to June 18th.  See the link to the RFI above for the HHS email address.    

05/12/2022

The Nature Conservancy's Dr. Robert McDonald Discusses International Efforts to Address Biodiversity Loss (May 11th)

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Coincident to the United Nations' 1992 creation of the Framework Convention on Climate Change (UNFCCC) agreement that governs international efforts to address the climate crisis/reduce Anthropocene warming, the UN also created the Convention on Biological Diversity (CBD) that attempts to address or maintain biodiversity or mitigate declining biodiversity worldwide.  The CBD has been ratified by every UN member state except the US.  Tragically, over the past thirty years both the UNFCCC and the CBD have achieved extremely limited success.  The CBD's current Global Biodiversity Framework (GBF) is largely an attempt to achieve the CBD's 2010 Aichi agreement that failed to attain any of its 20 biodiversity targets.  The GBF currently proposes 21 targets and 10 milestones.  The next CBD meeting, or Conference of Participants (COP) 15, is scheduled for this August in China where it is hoped signatories will reach consensus and approve the GBF.  Concerning the state of planetary biodiversity, currently an estimated 10% of insect species are at risk of extinction, 13% of bird species, 21% of reptile species, 25% of mammals and 40% of amphibians.

During this 35 minute interview Dr. McDonald begins by providing an assessment of overview of planetary biodiversity loss and his understanding of why on balance the US health care industry fails to appreciate the relationship or correlation between biodiversity, or the health of ecosystems, with human health.  He then provides an overview of the UN Convention of Biological Diversity, the failure of the 2010 Aichi agreement, the goals of the currently negotiated Global Biodiversity Framework and the likelihood of its adoption at the scheduled CBD meeting in China this August.   

Dr. Robert McDonald is Lead Scientist for Nature-Based Solutions at The Nature Conservancy. He researches the impact and dependencies of cities on the natural world and helps direct the science behind much of the Conservancy’s urban Tnc_36544076_1920x1920 conservation work.  Prior to joining The Nature Conservancy, Dr. McDonald was a Smith Conservation Biology Fellow at Harvard University where he studied the impact global urban growth is having on biodiversity and conservation.  He also taught landscape ecology at Harvard’s Graduate School of Design, i.e., helped architects and planners incorporate ecological principles into their projects.  He holds a BS degree in biology from The University of North Carolina at Chapel Hill and a PhD in Ecology from Duke University.  He has published more than 50 peer-reviewed publications and a recent book published by Island Press and titled, Conservation for Cities.  It documents the role green infrastructure can play in the well-being of urban residents. 

Information on the United Nation's Convention on Biological Diversity is at:https://www.cbd.int/.   

05/05/2022

260th Podcast Interview: Sherill Mason Discusses Proposed Skilled Nursing Facility (SNF) Policy Reforms (May 4th)

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There are currently approximately 15,500 Skilled Nursing Facilities (SNFs) in the US providing care to approximately 1.5 million Americans at an annual cost of approximately $175 billion.  Research has for decades demonstrated SNF care quality lags - made tragically evident by the ongoing COVID pandemic.  As MedPAC termed in its recent March report, the pandemic's effects on SNF patients have been “devastating.”  Dedicated podcast listeners may recall I’ve discussed SNF care quality, for example the long standing abusive use of antipsychotics as chemical restraints in December 2012, again in February 2018 when I noted in testimony before the Congress in 2007 the FDA's Dr. David Graham stated, "15,000 elderly people in nursing homes [are] dying each year from the off-label use of antipsychotic medications for an indication that the FDA knows the drug doesn't work," and again in August 2020.  (Last September the The New York Times published a lengthy investigative report that found SNFs had gamed the misuse of antipsychotics by fraudulently diagnosing their elderly patients as schizophrenic.)  Concerning recent policy reform proposals, they are numerous.  In late February the White House published a fact sheet that identified numerous reforms, in early April the National Academy of Medicine issued a report titled, “The National Imperative to Improve Nursing Home Quality" that did the same.  In mid-April CMS published its proposed 2023 SNF rule that also did so.  Listeners will recall I interviewed Sherill in August 2013 regarding  post-acute Medicare fraud and in September 2015 regarding a value-based home health care demo.  

During this 41-minute interview Ms. Mason begins by discussing the private equity's effect on the SNF industry and CMS' recent decision to make public SNF (and hospital) ownership information.  The discussion moves on to discuss policies including to improving SNF staffing ratios, payment reform, front line worker education and training, addressing the abusive use of antipsychotics and regulatory enforcement and penalties.      

Ms. Sherill Mason is Principal at Mason Advisors where she specializes in federal legislative, reimbursement and regulatory initiatives that impact the post acute health care industry.  Prior to establishing Mason Advisors, Ms. Mason was a senior policy analyst with Marwood Group, providing detailed analyses of post acute health care legislative and regulatory initiatives to hedge funds and mutual funds.  Before joining Marwood Group, Ms. Mason operated Mason & Garvey, LLC, a private consulting practice, for six years where she 1517742789513 analyzed health care reform legislation and its potential impact on the senior living industry.  Prior still, Ms. Mason served as Senior Vice President of Resident Care & Services for Sunrise Senior Living, with responsibility for program development and the quality of care and services provided to 40,000 residents by 30,000 employees in 370 communities, operating in the United States, the United Kingdom, and Canada.  For seven years Ms. Mason was a Director with the Senior Care Services advisory practice of KPMG LLP, and served as KPMG’s National Subject Matter Expert for the home health, hospice, durable medical equipment, and home infusion therapy industries.   Ms. Mason is a Registered Nurse and earned a Bachelor of Arts Degree in American Studies with Distinction from Eckerd College. Her remarks regarding senior care have been published in the New York Times, Wall Street Journal.com, and MSNBC.com. In 2004, she was listed in the Washington Post as one of the top ranked business women in Washington, D.C. Ms. Mason’s writings have been published in Faulkner & Gray’s 1997 Managed Home Care Source Book; RN Magazine; CARING; ADVANCE Magazine and Nursing Spectrum. She provided advice on senior care technology to Senator John Edwards’ 2008 presidential campaign. Ms. Mason provided assistance to the Senate Finance Committee as it crafted the IMPACT Act of 2014.  For several years Ms. Mason was a guest lecturer at University of Pennsylvania, lecturing senior nursing students and Wharton undergraduates on the Affordable Care Act and government reimbursement for health care.  

President Biden's February 28th fact sheet is at: https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/28/fact-sheet-protecting-seniors-and-people-with-disabilities-by-improving-safety-and-quality-of-care-in-the-nations-nursing-homes/).  The NAM report is at: https://www.nationalacademies.org/news/2022/04/wide-ranging-systemic-changes-needed-to-transform-nursing-homes-to-meet-needs-of-residents-families-and-staff and information regarding CMS' proposed 2023 SNF rule is at: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2023-skilled-nursing-facility-prospective-payment-system-proposed-rule-cms-1765-p#:~:text=As%20a%20result%20of%20this,%241.7%20billion%2C%20in%20FY%202023.   The NBER paper discussed during this interview is at: https://www.nber.org/papers/w28474.  

04/29/2022

Dr. Lynn Parramore Discusses Neoliberalism's Effects on the Economy and Health Care (April 28th)

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This interview relates to numerous previous podcasts, however, to date I have not specifically discussed economic neoliberalism.  The effects of economic neoliberal theory (and its related political movement) underlies recent interviews with, for example, Dr. Steven Woolf and Prof. Kathleen Mullan Harris regarding declining US life expectancy, with Prof. Carol Graham regarding diseases and deaths of despair, with Prof. Katz Olson regarding her recently published book, Ethically Challenged, Private Equity Storms US Health Care, last year's interview with Brian Alexander regarding work, The Hospital: Life, Death and Dollars in Small Town America and the year prior with Prof. William Darity regarding his, From Here to Equality, Reparations for Black Americans.  

During this 32-minute interview Dr. Parramore begins by providing an overview of the theology of neoliberalism including comment on decades of wage stagnation, i.e., Lance Taylor's research.  She discusses neoliberalism's effect on racial equity and health equity, private equity's effects on health care specific to ED staffing via Contract Management, e.g., leads to moral injury, and policy solutions to better police unfettered neoliberalism.             

Dr. Lynn Parramore is Senior Research Analyst at the Institute for New Economic Thinking (INET) in New York City.  A cultural theorist who studies the intersection of culture and Parramore economics, she is Contributing Editor at AlterNet, where she received the Bill Moyers/Schumann Foundation fellowship in journalism for 2012. She is also a frequent contributor to Reuters, Al Jazeera, Salon, Huffington Post, and other news media outlets.  Her first book of cultural history, Reading the Sphinx (Palgrave Macmillan) was named a “Notable Scholarly Book for 2008” by the Chronicle of Higher Education.  A web entrepreneur, Dr. Parramore is co-founder of the Next New Deal (formerly New Deal 2.0) blog of the Roosevelt Institute, where she served as media fellow from 2009-2011, and she is also co-founder of Recessionwire.com, and founding editor of IgoUgo.com.  She has taught writing and semiotics at NYU and has collaborated with some of the country’s leading economists , including Corporations for the 99% with William Lazonick and New Economic Visions with Gar Alperovitz.  In 2011, she co-edited a key documentary book on the Occupy Movement titled, The 99%: How the Occupy Movement is Changing America.  Dr. Parramore received her Ph.D. from New York University.   

Dr. Parramore's INET writings discussed during this interview are at: https://www.ineteconomics.org/research/experts/lynnparramore

04/17/2022

Ms. Tina Burbine and Ms. Yolanda Smith Discuss Hospital at Home or the Acute Hospital Care at Home (AHCaH) Initiative (April 15th)

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Johns Hopkins is generally cited as the first to pilot the Hospital at Home care model over 20 years ago.   The model has been subsequently adopted by the VA and overseas in Australia, Canada, Israel and the UK among other countries.   CMS first tested the model in 2014 when it awarded Mount Sinai a grant to test the model, however, the model was not expanded having failed to the meet statutory criteria for expansion.  In order to better manage hospital capacity and reduce COVID infections, in 2020 under its waiver authority CMS allowed hospitals to provide alternative sites of acute care including homes.  Per research published by CMS this past December there are 186 hospitals across 33 states that have implemented the AHCaH model.  Currently, CMS' AHCaH model will last last as long as the Public Health Emergency (PHE) - that HHS just extended until July.  Hospital at Home research findings have been on balance favorable.  For example, research published in 2018 in JAMA found hospital at home patients had comparably lower rates of readmissions, ED and Skill Nursing visits and were more likely to rate their hospital care highly, research findings are however compromised by selection bias.   

During this 35 minute discussion Ms. Burbine and Ms. Smith by providing additional model details, i.e., where care can be provided, how patients enter the program, what conditions are treated and related details.  The interviews moves on to discuss participation rates, broadband prerequisites and EHR technology, clinical findings or results achieved, required pre-requisites for providing acute care at home, how AHCaH aligns with fee for volume medicine, participation in the commercial market, relationship to patient self-management, proposed legislative and regulatory policies to expend the model and takeaways from related experience overseas.        

Ms. Tina Burbine is Vice President Care Innovation & Enterprise Analytics at HealthLink Advisors.  Tina has over 25 years of value-based care, population health and healthcare IT Unnamed experience.  Throughout her career Tina has focused on shaping the strategic approach for health systems moving to value-based care enabling teams to focus on keeping their patients healthy, addressing rising risk and improving the health of those with chronic conditions through evidence-based, cost-effective care delivery. This includes establishing payer partner relationships, network management, provider relations, and technology enablement to support innovative community-specific care models.  Tina serves on the Arizona HIMSS Chapter Board, lectures at the University of Arizona’s BioMedical Informatics College Fellowship program and hosts a podcast called “Let’s Talk Data!"  Tina earned a Bachelor’s degree from Northern Arizona University and an MBA from the University of Phoenix.

Ms. Yolanda Smith is Chief Clinical Officer at HealthLink Advisors.  Yolanda has accrued 35 years of experience in medical care, having served as an ICU nurse, clinical care educator, and consultant throughout her career.  She is currently focused on operational care delivery redesign for Hospital at Home (H@H) and Community Care enablement, strategy, and 1646312436374 performance to make sure patient needs are anticipated and met.  Yolanda has served as the curriculum developer and trainer for SEIU 1199, creating and implementing extensive and intensive in-services, curricula, and seminars throughout New York State for hospitals and healthcare systems across the care continuum.  Yolanda is a licensed RN, holds an MSN, and is pursuing a Doctorate of Nursing Practice (DNP) degree in the Healthcare Systems Leadership Specialty Track at Chamberlain University.

The NEJM overview by CMS staff of the AHCaH model is at: https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0338.  Related clinical findings published in Annals is at: https://www.acpjournals.org/doi/10.7326/M19-0600.   CMS' FAQ regarding the AHCaH model is at: https://www.capc.org/documents/download/882/

04/13/2022

Latest Essay: "HHS's Failure to Address the Health Harms of the Climate Crisis Constitutes Environmental and Institutional Racism" (April 13)

On March 28th STAT News published my latest climate crisis-related essay, again titled, "HHS's Failure to Address the Health Harms of the Climate Crisis Constitutes Environmental and Institutional Racism."  The essay is at: https://www.statnews.com/2022/03/28/hhss-failure-to-address-the-health-harms-of-climate-crisis-constitutes-environmental-and-institutional-racism/.   

The article concludes, in part, "Per [President] Clinton's executive order requiring agencies to develop environmental justice strategies, it appears the [HHS] Office of Climate Change and Health Equity [OCCHE] now owns this responsibility, though it does not identify any environmental justice strategies."   

Eleven days after the article appeared, HHS published brief, 700-word Request for Information (RFI) soliciting public comment on an, "HHS environmental justice strategy and implementation plan draft outline."  The RFI is at: https://www.govinfo.gov/content/pkg/FR-2022-04-08/pdf/2022-07514.pdf.  Listeners are encouraged to forward comments in response to the RFI.  Comments are due May 19th.