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4 posts from April 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


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/


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. 


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.