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3 posts from May 2022

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.