Lawmakers aim to block Medicare payment cuts to doctors, but clock is ticking

Lawmakers in Congress are working to prevent planned Medicare payment cuts to physicians, much to the relief of a host of healthcare organizations.

Republicans and Democrats have sponsored a bill to avoid Medicare’s scheduled reduction in physician payments for 2025. The Centers for Medicare & Medicaid Services have proposed a 2.8% cut in payments to doctors next year.  This despite the annual inflation rate of 2-5% annually.

The AMA said that Medicare payment rates have dropped 29% over the past 20 years, when including the higher costs of running practices. Doctors and their advocacy groups have said the continued cuts in recent years could hurt access to care, as physicians leave the profession or they opt not to accept Medicare patients.

On Tuesday, lawmakers introduced the legislation, dubbed the Medicare Patient Access and Practice Stabilization Act. U.S. Reps. Greg Murphy, R-N.C., and Jimmy Panetta, D-Calif., are the prime sponsors, but other lawmakers, Republicans and Democrats alike, are backing the measure.

In addition to averting the cuts, the legislation would give doctors increases in payments that are equivalent to half the Medicare Economic Index, which reflects changes in the annual operating costs for physicians.

“Medical inflation is much higher and the cost of seeing patients continues to rise,” Murphy said. “Unfortunately, reimbursements continue to decline, putting immense pressure on doctors to retire, close their practices, forgo seeing new Medicare patients, or seek a less efficient employment position. 

Many physicians merged with other physicians or agreed to be purchased by venture capitalists, supposedly improving effficiency having a larger group, and consolidating management.   None of this proved to be true, and the downward spiral has continued.

This bipartisan legislation would stop yet another year of reimbursement cuts, give them a slight inflationary adjustment, and protect Medicare for physicians and patients alike."

Lawmakers aim to block Medicare payment cuts to doctors, but clock is ticking

How are emergency departments in the US going to deliver high-quality care

How are emergency departments in the US going to deliver high-quality care if payments to emergency medicine practices continue to decrease from private insurance companies, government insurers, and patients - all at the same time? 

A strong emergency medicine system needs a stable funding source to deliver 24-7 care to acutely ill and injured people, no matter where they live or who they are. Do we really want to skimp on life-saving care?

Check out the article, "UnitedHealth Emails Reveal Tension Over Cuts to Doctor Pay" in Bloomberg by John Tozzi. Excerpt:

Doc Pay Cuts Sparked Strife at Insurer

UnitedHealth Group systematically cut its payments to out-of-network doctors for emergency department (ED) visits and mental health care, sparking internal tension, according to newly unsealed court documents reported by Bloombergopens in a new tab or window.

The records open a window into the workings of its UnitedHealthcare unit, the largest U.S. health insurer, and shed light on a bitter battle between financial heavyweights in the $5 trillion U.S. medical system,"UnitedHealth Group Inc. systematically cut what it paid for emergency room visits and mental health care to doctors outside of its network, sparking internal tension over how those changes were handled and the potential effect on members, newly unsealed court documents show.

The records open a window into the workings of its UnitedHealthcare unit, the largest US health insurer, and shed light on a bitter battle between financial heavyweights in the $5 trillion US medical system. Doctors have long blamed the company for refusing to fully cover their bills, with private equity-backed physician groups filing a string of lawsuits accusing it of shortchanging clinicians from outside of its insurance network.

...The senior vice president questioned plans to cut reimbursement levels for out-of-network emergency room visits. UnitedHealth had already reduced payments from 450% of what Medicare pays — the benchmark that many insurers use as a starting point for their own figures — to 250%, and the company planned to drop it further to 150%, according to the email.

How can an emergency room visit be out of network?  A patient with a critical condition such as crushing chest pain, loss of consciousness, stroke is taken to the nearest level I or II emergency deparrtment, by law. To do so otherwise would be against standard of care.

At the April trial, an executive testified that the company didn’t move forward with the deepest cuts, according to a transcript.

Such a cut would have put UnitedHealth below national averages: Employers and private insurers paid on average about 250% of Medicare’s reimbursement in 2022, researchers from the Rand Corp. reported, counting both in-network and out-of-network rates. Providers often accept discounted payments in exchange for network agreements that give them greater access to patients.

hashtag #emergencymedicine

#American College of Emergency Physicians

#American Academy of Emergency Medicine (AAEM)

#Society of Emergency Medicine Physician Assistants (SEMPA)

#Society for Academic Emergency Medicine

#Society of Physician Entrepreneurs

Numerous employers brought suite against UHC

‘Californian Votes Really Matter’: What the Election Could Mean for Reproductive Health | KQED

Dr. Sophia Yen finds it difficult to talk about the future her daughters could face under a second Trump presidency without tearing up.

Yen, co-founder of an organization specializing in reproductive care, fears their access to such vital care could be further limited if former President Donald Trump wins the election. And she’s not alone.

“How do I get two girls through college?” Yen asked, pointing to the fact that 1 in 4 undergraduate women have reported being sexually assaulted.

Nationwide, she said, reproductive rights have “already gone back. And we need to fix it.”

After the Supreme Court overturned Roe v. Wade in 2022, spurring some states to limit access to abortion, infant mortality rates increased — in Texas, by as much as 13%. Pinning down the maternal mortality rate is harder. According to a recent study from the Commonwealth Fund, women were more at risk of dying at or around childbirth in states with stricter abortion laws. In Texas, the maternal mortality rate rose 56% from 2019 to 2022, while nationally, it ticked up 11%, according to the research nonprofit Gender Equity Policy Institute.

According to a Gallup Poll released this summer, 54% of Americans identify as pro-choice, maintaining “historically high levels” of support for abortion rights since the overturning of Roe v. Wade. And 32% of registered voters said they would only vote for a candidate that shared the same views as them on abortion, up 8 points since 2020.

In an election featuring two candidates with wildly differing views on abortion who are polling extremely closely, Bay Area residents and experts are left to wait and see what the future of healthcare holds.

Even though state laws protect the right to an abortion in California, Yen — who is also a professor at Stanford Medical School — said the stakes are still high for abortion-rights voters in the Bay Area.

“For Californians, we think we’re protected,” she said. “But we’re not.”

In truth the Dobbs Act, rescinding the Federal decision to allow abortions, the Dobbs act moves the dedecision to the states.   Many states have already passed laws allowing abortion under certain circumstances.

alifornian Votes Really Matter’: What the Election Could Mean for Reproductive Health | KQED

Better Surgery?

Stop the B.S.

A decade ago, a Pew survey found that 92% of Americans preferred financial 𝘀𝘁𝗮𝗯𝗶𝗹𝗶𝘁𝘆 over upward 𝗺𝗼𝗯𝗶𝗹𝗶𝘁𝘆. If we asked for a healthcare equivalent today, the answer would be the same: people want a stable, functional, reliable healthcare system more than the latest drug, device, or procedure.

Yet, the system churns out endless “progress” and “innovation”:
💊 A new drug with fewer side effects!
🪚 A better surgical technique with less bleeding!
🩸 A blood test that cuts ER visit times by 12 minutes!

Medical research never asks: How do we make care feel stable and dependable? Where are the innovations that get you an appointment in 1 week instead of 2 months? Where is the NIH grant focused on creating day-to-day reliability?

Maybe we’re just building products that don’t fit what the “customer” wants. Do we have no product-market fit?

Mad In America

This article will be quite controversial to allopathic physicians who only treat illness with FDA-approved medications. However, some psychiatrists are more attuned to off-label or alternative treatments.

Several vitamin deficiencies have been linked to mental health issues. Here are some notable ones:

1. **Vitamin B12**: Deficiency can lead to cognitive decline, memory issues, and mood disturbances such as depression.

2. **Folate (Vitamin B9)**: Low levels are associated with depression and increased risk of mental disorders.

3. **Vitamin D**: Deficiency has been linked to depression, anxiety, and other mood disorders.

4. **Omega-3 Fatty Acids**: While not a vitamin, low levels can contribute to depression and cognitive decline.

5. **Vitamin B6**: Important for neurotransmitter synthesis; deficiency can lead to irritability and depression.

Maintaining a balanced diet rich in these vitamins can help support mental health. If you suspect a deficiency, it's advisable to consult a healthcare professional.

The Shamanic View of ‘Mental Illness’: Birth of a Healer

There is a distinct difference between 'healers' and physicians. Some physicians are healers. They call themselves "alternative medicine" or "integrative medicine".  

Relate topics:

Will Denial Make DSM’s Validity Problem Go Away?

The Drug-based Approach to Mental Illness Has Failed

Billions of Dollars Later, Neuroscientists Still Struggling to Address Mental Health Crisis

Scores of Papers by Top NIH Neuroscientist Eliezer Masliah Fall Under Suspicion

Masliah appeared as an ideal selection. The physician and neuropathologist conducted research at the University of California San Diego (UCSD) for decades, and his drive, curiosity, and productivity propelled him into the top ranks of scholars on Alzheimer’s and Parkinson’s disease. His roughly 800 research papers, many on how those conditions damage synapses, the junctions between neurons, have made him one of the most cited scientists in his field. His work on topics including alpha-synuclein—a protein linked to both diseases—continues to influence basic and clinical science.

After Science brought initial concerns about Masliah’s work to their attention, a neuroscientist and forensic analysts specializing in scientific work who had previously worked with Science produced a 300-page dossier revealing a steady stream of suspect images between 1997 and 2023 in 132 of his published research papers. (Science did not pay them for their work.) “In our opinion, this pattern of anomalous data raises a credible concern for research misconduct and calls into question a remarkably large body of scientific work,” they concluded.

Following an investigation, the National Institutes of Health (NIH) has made findings of research misconduct against Eliezer Masliah, M.D., due to falsification and/or fabrication involving re-use and relabeling of figure panels representing different experimental results in two publications. NIH will notify the two journals of its findings so that appropriate action can be taken. NIH initiated its research misconduct review process in May 2023 after it received allegations from the HHS Office of Research Integrity (ORI) that same month. NIH began its investigation phase in December 2023, concluded its investigation of these allegations on September 15, 2024, and notified HHS ORI of its findings.

Dr. Masliah joined the agency in the summer of 2016 as director of the Division of Neuroscience (DN) at the National Institute on Aging and an NIH intramural researcher investigating synaptic damage in neurodegenerative disorders. He has published numerous papers as an NIH intramural researcher. Currently, Dr. Masliah is not serving in the capacity of director of the NIA DN.

These findings alert those who depend upon peer-reviewed articles that are always subject to questioning and challenge.  That is the scientific method.

Capitalism Is Driven by Mental Illness

Beyond Pharmacare

Targeted: For Those Who Hear Voices, the ‘Broken Brain’ Explanation Is Harmful

Psychiatric Diagnoses Don’t Explain ‘Why’—Only ‘How’

Microbes and Mental Illness

Nearly a Third of Adolescents Getting Mental Health Treatment, Federal Survey Finds

The full Biblio is below.

Blogs Archives - Page 2 of 189 - Mad In America

Sleep is integral to cardiovascular health

Sleep is integral to cardiovascular health1,2. 

A possible relationship with poor or inadequate sleep cycles and the effect of poor sleeping habits may contribute to acute myocardial infarction.

Yet, the circuits that connect cardiovascular pathology and sleep are incompletely understood. It remains unclear whether cardiac injury influences sleep and whether sleep-mediated neural outputs contribute to heart healing and inflammation. 

Here we report that in humans and mice, monocytes are actively recruited to the brain after myocardial infarction (MI) to augment sleep, which suppresses sympathetic outflow to the heart, limiting inflammation and promoting healing. After MI, microglia rapidly recruit circulating monocytes to the brain’s thalamic lateral posterior nucleus (LPN) via the choroid plexus, where they are reprogrammed to generate tumor necrosis factor (TNF). In the thalamic LPN, monocytic TNF engages Tnfrsf1a-expressing glutamatergic neurons to increase slow-wave sleep pressure and abundance. 

Proposed interconnection between inflammation of myocardial infarction and sleep

Disrupting sleep after MI worsens cardiac function, decreases heart rate variability, and causes spontaneous ventricular tachycardia. After MI, disrupting or curtailing sleep by manipulating glutamatergic TNF signaling in the thalamic LPN increases cardiac sympathetic input which signals through the β2-adrenergic receptor of macrophages to promote a chemotactic signature that increases monocyte influx. 

Poor sleep in the weeks following acute coronary syndrome increases susceptibility to secondary cardiovascular events and reduces the heart’s functional recovery. 

In parallel, insufficient sleep in humans reprogrammes β2-adrenergic receptor-expressing monocytes toward a chemotactic phenotype, enhancing their migratory capacity. Collectively, our data uncover cardiogenic regulation of sleep after heart injury, which restricts cardiac sympathetic input, limiting inflammation and damage.

Long COVID is a Brain Injury

Recent research utilizing ultra-high-field MRI scans has identified microstructural abnormalities in the brainstems of COVID-19 survivors. These findings suggest a neuroinflammatory response that may explain the persistent symptoms of long COVID, such as breathlessness and brain fog. These findings highlight similarities between long COVID and traumatic brain injury, emphasizing the need for further investigation into shared inflammatory pathways and potential treatment strategies.

Brainstem Damage

Brain Stem Structural Abnormality

MRI shows brain microstructural changes after mild COVID-19

Ultra-high field (7 Tesla) MRI scans have uncovered microstructural abnormalities in the brainstems of COVID-19 survivors, persisting for months after hospitalization12. These changes, primarily localized in the pons and medulla regions, are consistent with a neuroinflammatory response2. The abnormalities were more pronounced in patients who experienced longer hospital stays, higher disease severity, and more prominent inflammatory responses during acute illness2. This groundbreaking imaging technique allows researchers to examine brainstem nuclei in living participants, providing unprecedented insights into the long-term neurological effects of COVID-193.

Severe Long Covid Inflammatory Reaction

MRI study spotlights the impact of long COVID on the brain

Symptoms

Persistent symptoms associated with brainstem damage in long COVID patients include breathlessness, fatigue, brain fog, and difficulties with blood pressure regulation12. These symptoms are believed to result from inflammation in areas of the brainstem responsible for controlling vital functions such as breathing and heart rate23. Interestingly, the symptom profile shares similarities with functional neurological disorders, chronic fatigue syndrome, and persistent post-concussive syndromes4. Research has shown that abnormalities in the medullary reticular formation, a region central to breathing control, may explain the long-lasting respiratory symptoms experienced by some patients

Brain Injury Parallels

Recent studies have uncovered striking similarities between long COVID and traumatic brain injury (TBI), particularly in terms of neuroinflammation and blood-brain barrier (BBB) disruption. Research using dynamic contrast-enhanced magnetic resonance imaging has revealed BBB disruption in patients with long COVID-associated cognitive impairment, commonly referred to as brain fog1. This BBB dysfunction is reminiscent of the vascular disruption observed in TBI cases.

The inflammatory response in both conditions appears to share common pathways:

Sustained systemic inflammation leading to increased production of cytokines and reactive oxygen species

Increased BBB permeability allows cytokines to penetrate the brain2

Activation of microglia and astrocytes, potentially interfering with neurotransmitter production

Possible persistence of viral antigens or autoantibodies contributing to chronic immune system activation2

These shared inflammatory mechanisms may explain why individuals with a history of both COVID-19 and TBI tend to experience more severe and prolonged symptoms3. The cumulative effect of neuroinflammation from previous brain injuries combined with the inflammatory impact of COVID-19 could create a "perfect storm" for persistent neurological symptoms34. This connection underscores the importance of considering a patient's history of brain trauma when assessing and treating long COVID symptoms.

Long COVID is a Brain Injury

Pfizer Batch Code Starting with "E" Means "Everyone is Potentially at Risk"

Early batches of C19 vaccines were contaminated with DNA and other impurities.  New batches may offer more safety.

Pfizer Batch Code Starting with "E" Means "Everyone is Potentially at Risk"

Look for "E"

"Five lots had high outliers for death (i.e., EL0140, EL9261, EL3248, EN9581, and EJ1686); four for serious (EK4176, EK5730, EH9899, and EJ1685), and five for ALL SAEs (EK5730, EH9899, EK4176, EK9231, and EJ1685). These vaccinations were the first to be distributed in December 2020 and early 2021."

Jabbed? Keep Your Records and Search Your Batch
Pfizer’s lots or batches have been evaluated and studied for variation in risk by Schmeling, Manniche, and Jablonowski. All three studies have concluded the earlier batches were more lethal and the variation in risk was considerable from lot to lot. Now Jablonowski and Hooker report:
"Five lots had high outliers for death (i.e., EL0140, EL9261, EL3248, EN9581, and EJ1686); four for serious (EK4176, EK5730, EH9899, and EJ1685), and five for ALL SAEs (EK5730, EH9899, EK4176, EK9231, and EJ1685). These vaccinations were the first to be distributed in December 2020 and early 2021."

A search of 'How Bad is My Batch' revealed that 1266 (26.4%) of the 4790 Pfizer batches at at least one death reported in VAERS. Of the top 100 batches with the highest crude deaths, 96% started with the letter “E.” When lethality or percent of fatal adverse reports was searched, 55% started with “E.”

Read on Courageous Discourse: https://shorturl.at/Ijlqz

hashtag#MFScholar

Navigating the Post-Election Healthcare Landscape

 Will you. vote Democratic or Republican?

Does it matter?  Health Train Express has analyzed your choices.

Yes, there are significant differences between the healthcare platforms of Democrats and Republicans in the United States. Here are some key distinctions:

### Democrats

1. **Universal Coverage**: Many Democrats support initiatives aimed at achieving universal health care coverage, often advocating for a single-payer system or expanded public options like Medicare for All.

  2. **Affordable Care Act (ACA)**: Democrats typically aim to strengthen and expand the ACA, which includes provisions for protecting individuals with pre-existing conditions and expanding Medicaid in states that have opted for it.

3. **Regulation of Pharmaceutical Prices**: They often support measures to lower prescription drug prices and increase transparency in health care costs.

4. **Public Health Investments**: Democrats generally emphasize the importance of investing in public health and preventive care.

### Republicans

1. **Market-Based Solutions**: Republicans tend to favor market-oriented approaches, promoting competition among private insurers and reducing government involvement in health care.

2. **Repeal/Modification of the ACA**: Many Republicans have sought to repeal or modify the ACA, arguing that it leads to increased costs and reduced choices for consumers.

3. **Health Savings Accounts (HSAs)**: They often promote HSAs as a way for individuals to save for medical expenses with tax advantages, encouraging consumer-driven health care.

4. **Less Regulation**: Republicans typically advocate for less regulation of the healthcare industry, believing that this will lead to lower costs and greater innovation.

### Summary

In summary, Democrats generally support more government involvement and regulation in health care to ensure broader coverage and lower costs, while Republicans emphasize market-driven solutions and personal choice with less government intervention.

The post-election landscape has the potential to bring changes to organizations across the healthcare ecosystem, from healthcare services providers to pharma and biotech, necessitating immediate strategic considerations. These potential shifts—as well as how executives and investors can stay ahead of them—will be front and center in this important webinar convened by the healthcare-focused advisory team at FMG Leading.

Join our esteemed panel of healthcare leaders for a glimpse of what’s ahead and the strategies that foster institutional change readiness, including:

• Identifying and analyzing performance drivers, as well as institutional strengths and gaps, to help focus collective energies and investments
• Properly equipping and preparing the key leaders and teams who play an outsized role in expediting scale
• Embedding a growth mindset—and the ability to execute it— into organizations already contending with healthcare’s pressing challenges
• Elevating the importance of growth among those whose primary purpose is tied to care delivery and clinical outcomes
• Accelerating scalability post-M&A or integration through proven people-focused strategies 

Although there are radical differences these proposals face congressional approval and there are challenges ahead for some of these ideas. Some of these ideas are radically different.  Because there are serious differences and disagreements the upcoming election is open to a guess given the close analysis of the impending election within the bounds of statistical accuracy.

If you have an opinion please vote.

Navigating the Post-Election Healthcare Landscape | Fierce Healthcare

Pill Puncher | Your Easy Solution for Opening Medication

The Sunday Morning Extra

The most efficient tool for opening medicine blister packs

Are you tired of struggling to open medicine blister packs? Thanks to Pill Puncher, you won't have to stress anymore. Our inventive and user-friendly device eliminates the frustration associated with medication management, allowing you to access your pills more easily and without hassle. When you use it, you can cut, remove, and dispense your pill all at once.

But that's not all - we also allow for the white labeling of our blister pack openers. 

Pill Puncher | Your Easy Solution for Opening Medication

No more dropping pills as they shoot out of the blister pack. No more broken pills.

This is especially useful for aged patients who may have tremors and a weak grip.