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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. 

04/05/2022

Third Installment of the IPCC's Sixth Report Is Published: Overshooting 1.5C of Warming is "Almost Inevitable" (April 4)

Yesterday, the UN's IPCC released its third section of its latest, or sixth, report.   Among other findings, the authors' concluded overshooting 1.5C is "almost inevitable," and investments in the shift to a low-carbon world is about six times lower than they need to be.  As the co-chair of the working group, Jim Skea of the Imperial College of London, stated,  "it's now or never” regarding keeping warming to 1.5C.   Regarding governments' efforts to date, UN Secretary General Guterres stated, "some government and business leaders are saying on thing - but doing another.  Simply put, they are lying.  And the results will be catastrophic."   Since it takes the IPCC six to seven  years to produce these reports, this is likely last report before the planet experiences climate breakdown, or what’s termed Hothouse Earth: https://www.pnas.org/doi/epdf/10.1073/pnas.1810141115.   Finally, concerning US media coverage, that remains beyond incompetent, go to nytimes.com and look to find their coverage of the report.   To save time: scroll to the bottom of he page and work your way up.  

Here’s the 63-page summary of the report: https://report.ipcc.ch/ar6wg3/pdf/IPCC_AR6_WGIII_SummaryForPolicymakers.pdf.

 

03/31/2022

Prof. Laura Katz Olson Discusses Her Just-Published, "Ethically Challenged: Private Equity Storms US Health Care" (March 30)

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In her just published Johns Hopkins University Press book, "Ethically Challenged, Private Equity Storms US Health Care," Professor Olson’s describes how and why Private Equity (PE) firms over the past forty years have purchased an ever-increasing number of acute and post-acute providers, physician groups, dental practices and a long list of health care ancillary services and what impacts PE firms have had/are having on the affordability and delivery of health care.  In 2020, PE constituted a $5 trillion industry with approximately 3,750 firms owning over 8,000 companies.  The US has the most corporatized healthcare system in the world.  

This 39 minute interview begins with Prof. Olson explaining briefly what prompted her to research and write the book.  She moves on to providing an overview of how PE firms operate or what's their playbook, briefly notes as an example the demise Philly's Hahnemann University Hospital's, discusses the effect PE ownership has on health care delivery, explains the "corporate practice of medicine" doctrine, discusses what she learned from physicians who sold their practices to PE, Congressional efforts to reform the PE industry including the "Stop Wall Street Looting Act," PE-related surprise billing legislation, PE performance during the pandemic, and suggests further policy reforms to better policy PE investments in healthcare.                       

Laura Katz Olson is a Distinguished Professor of Political Science at Lehigh University.  She earned her undergraduate degree at the City College of New York (CCNY) and her Ph.D. in political science at the University of Colorado Boulder.  Professor Olson has published nine books, the most recent of which is Elder Care Journey: A View from the Front Lines (SUNY Press, 2016).  Her other books include: The Politics of Medicaid (Columbia University Press); The Political Laura-photo-web Economy of Aging: The State, Private Power and Social Welfare; Aging and Public Policy: The Politics of Growing Old in America; The Graying of the World: Who Will Take Care of the Frail Elderly; Age Through Ethnic Lenses: Caring for the Elderly in a Multicultural Society; The Not So Golden Year: Caregiving, the Frail Elderly and the Long-Term Care Establishment; The Handbook of Long-Term Care Administration and Policy; and Heart Sounds (her first novel)She has been a Scholar at the Social Security Administration, a Gerontological Fellow and a Fulbright Scholar.  She also has lectured throughout Pennsylvania on Social Security, Medicare and Long-term Care policies.  Professor Olson is on the editorial board of the Journal of Aging Studies and New Political Science.

Information concerning Prof. Olson's book is at: https://www.press.jhu.edu/books/title/12719/ethically-challenged.  

03/25/2022

Professor Katheleen Mullan Harris Discusses the NAS Report, "High and Rising Mortality Rates Among Working-Age Adults" (March 23)

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This discussion intends to bring listeners more up to date regarding declining life expectancy in the US via discussion of the National Academy of Sciences' 2021 consensus report, "High and Rising Mortality Rates Among Working-Age Adults."  This interview builds upon previous related discussions including my 2013 interview with Dr. Steven Woolf regarding the IOM’s related report, “Shorter Lives, Poorer Health,”  my January 2021 follow up interview with Dr. Woolf, my Brian Alexander interview in June 2021, my Professors Gibson-Davis and Hill interview last September and my Prof Carol Graham interview last November.   

During this 39 minute interview Prof Harris begins by providing an overview of the report's findings, e.g., what explains the increase in working age mortality and what subpopulations are being impacted.  She then discusses US life expectancy compared to other, like countries, the significant variation in life expectancy within the US, e.g., richest v. poorest 1%, she discusses the report's chapter ten, "the relationship between economic factors and mortality," discusses her related Senate HELP Committee testimony from last July touches on mental health, her related Senate HELP Subcommittee testimony last July especially her noting higher rates of disease among younger adults (think: living in an obesogenic environment) and her view regarding what policy reforms the report's findings suggest.        

Kathleen Mullan Harris is the James E. Haar Distinguished Professor of Sociology and Adjunct Professor of Public Policy.  She was awarded the Golden Goose Award from the US Harrisk Congress for major breakthroughs in medicine, social behavior, and technological research and the Irene Taeuber Award from the Population Association of America in recognition of original and important contributions to the scientific study of population.  Dr. Harris is past president of the Population Association of America, past president of the Interdisciplinary Association of Population Health Science, and an elected member of the National Academy of Sciences, Engineering, and Medicine, the American Academy of Arts and Sciences, and Fellow of the American Association for the Advancement of Science.

The NAS report is at: https://www.nap.edu/download/25976

Professor Mullan Harris's related July 2021 Senate HELP Committee testimony is at: https://www.help.senate.gov/imo/media/doc/Harris10.pdf

03/20/2022

255th Podcast Interview: Dr. Lise van Susteren Discusses the Psychological Effects of the Climate Crisis (March 18th)

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In a survey published late last year in The Lancet Planetary Health, coauthored by Dr. van Susteren, 10,000, 16-25 year olds across 10 countries including the US were surveyed to assess their level of climate anxiety and the beliefs about government responses to the climate crisis.  The survey found: 75% thought the climate crisis posed a frightening future; 66% were left afraid, anxious or sad; 60% were very or extremely worried about global warming; and, 56% thought humanity is consequently doomed.   Concerning governments' response to the climate crisis: 65% agreed governments were failing them; 64% agreed governments were lying about climate crisis-related impacts; and, 60% agreed they were dismissing their distress.  Suicides in the US have increased by 33% overall since 1999 and by twice this percent for 10-24 year olds.  Today, suicide is a leading cause of death in the US.   

During this 33 minute interview Dr. van Susteren begins by describing what is eco-anxiety and how does it manifests.  The discussion moves on to her assessment of David Buckel's widely reported 2018 suicide, where is the psychological field regarding recognizing climate anxiety in the DSM-5, what explains professional medical associations hesitance in addressing the climate crisis and the Biden administration's and the World Health Organization's refusal to declare a climate emergency, she explains the work of her cofounded organizations, Climate Psychiatry and the Climate Psychology Alliance - North America, addresses how best to respond to experiencing a weather disaster event, and finally she encourages those disturbed by the climate crisis to take action.            

Dr. Lise van Susteren is a general and forensic psychiatrist in Washington, DC, and an  expert on the physical and psychological impacts of climate change. In 2011 she co-authored "The Psychological Effects of Global Warming on the U.S. - Why the US Mental Health System Is Not Prepared".  Van Susteren is a Clinical Associate Professor of Psychiatry and Download Behavioral Sciences at George Washington University and has been a consultant to the Executive Branch of the US government profiling world leaders. After receiving her medical degree from the University of Paris she practiced medicine in West Africa, at community health centers and homeless shelters in the metropolitan Washington DC.  In addition to community organizing on climate issues, van Susteren serves on the Boards of Earth Day Network, Physicians for Social Responsibility and is a co-founder of "Climate Psychiatry Alliance," and of “Climate Psychology Alliance – North America,"  Van Susteren is the expert witness on the psychological damages to young people from inaction on climate in Juliana v US, in Held v Montana and in the European Court of Human Rights.  She is a frequent contributor on television, radio and in the print media.  In 2006 Dr. van Susteren sought the Democratic nomination to the US Senate from Maryland.  Her book, “Emotional Inflammation – Discover Your Triggers and Reclaim Your Equilibrium During Anxious Times” was published in April 2020.

The Lancet published survey is at: https://www.thelancet.com/action/showPdf?pii=S2542-5196%2821%2900278-3.  

Dr. van Susteren's letter to the editor of  The New York Times regarding David Buckel's 2018 suicide, discussed during this podcast, it is at: https://www.nytimes.com/2018/04/18/opinion/suicide-environmental-protest.html

If you are experiencing climate crisis despair and would like to reach out to Dr. van Susteren, her email address is: lvs350@me.com.