Tuesday, July 19, 2022

“Evil empire:” UnitedHealthcare schemes to intentionally underpay healthcare providers, lawsuits claims —

“Evil empire:” UnitedHealthcare schemes to intentionally underpay healthcare providers, lawsuits claims


It’s no secret that UnitedHealthcare is reducing provider networks across the nation while boosting its record-setting profits.  

And another company is fighting back: Envision Healthcare in Broward County, FL, filed a lawsuit against UnitedHealthcare in May, claiming UnitedHealthcare is scheming to underpay front-line healthcare providers and push them out-of-network.  An article in Becker’s Hospital Review says that Envision is seeking to recover millions of dollars in alleged underpayments for medical care it provided to UnitedHealth members.

Excerpts from the Envision lawsuit shine a light on how UnitedHealthcare allegedly operates:

United, the country's largest commercial health insurance company, engages in a nationwide pattern and practice of intentionally underpaying frontline healthcare providers to boost its profits. United's scheme is simple: issue drastically reduced "take it or leave it" reimbursement rates during contract negotiations to force providers out of its networks, rather than pay them fair and reasonable rates for their services, including saving lives during an unprecedented pandemic. 

Once United successfully forces a provider out of network, United then intentionally and significantly underpays the now "out-of-network" provider, often at rates even lower than the contract rates offered. United then lines its pockets with the money that providers have worked tirelessly to earn, money the providers deserve.”

This model is not limiited to United Health Group, nor is it a recent phenomenon.Every major health insurance plan has implemented this methodology against providers and institutions.It has been an ongoing model for two decades at the inception of preferred provider groups in the 1990s. At the same time health insurance premiums, deductibles, and copayments have increased.  The victims are the patients using providers as the weapon.  In Georgia it has reached the judicial level of adversarial contracting.

One lawsuit in one state may set a small precedent against the huge health insurance lobby.

Health Care Industry, the effects of "Deskless Working"

Health Care Industry Consulting and Strategy | BCG

Massive changes—including breakthroughs in digital health, the emergence of novel therapies, the rise of personalized care, and value-based care—are transforming health care.

At the start of 2020, the global health care industry was already facing transformational changes driven by shifting consumer behaviors, the rise of disruptive competitors, changing regulations, and new alliances and mergers. To thrive in the face of such change—and in the postpandemic world—health care leaders need to reimagine their strategies, value propositions, and organizational capabilities.  Health care consulting teams help clients do so by adopting agile ways of working, accelerating innovation, advancing digital transformation, evolving go-to-market strategies, and driving growth and portfolio strategy through M&A. Across virtually every engagement, experts can help clients optimize capabilities through data, digital, and advanced analytics.

Health Care Industry Work


Biopharmaceuticals consulting experts support clients across every aspect of the biopharma value chain, including R&D, operations, manufacturing, commercialization, and M&A, so companies can unlock innovation and bring new medicines to market faster.



Health care industry consultants work with payers, providers, health systems, and services to maximize innovation, unlock new sources of revenue, and improve patient outcomes and the quality of care.

 

Medical technology consulting experts help clients assess their priorities and strengths and then move decisively to innovate—in operations, marketing and sales, R&D, and other core parts of their business.

Close-up of two hands under an outdoor water spigot


We are working with global health organizations to launch and scale innovative interventions, fight disease, and manage overall population health.

Wednesday, July 13, 2022

Medicinal Cannabis, or Medical Marijuana,

Medicinal cannabis, or medical marijuana, has evolved from a controversial, misunderstood therapy, to a mainstream treatment option for a growing list of health challenges. As more states legalize marijuana for medical purposes—reducing pain, nausea and inflammation, decreasing anxiety, and aiding sleep, among other symptoms—interest in cannabis therapies has been growing among healthcare professionals.


In a past Sermo poll of 245 global physicians, 70% responded that they are interested in learning more about the power of cannabis medicine.

Despite a growing adoption and legalization movement—in the US alone, 37 states and Washington DC have legalized marijuana treatments—some in the medical field continue to question its efficacy, requesting more research and data before widely recommending treatment. In the same Sermo poll, only 22% of doctors said they have experience recommending cannabis to patients.

We want to hear from you and understand where you fall on the spectrum. Please fill out the poll below to give your thoughts on medical marijuana. We’d also love to hear about your patient cases and any additional thoughts in the comments section.

Iin addition to information about the herb, paraphernalia is a major source of contentment for users.  These include roll your own joints, e-dispensers (akin to e-cigarettes). ceramic pipes, vaporizers, bongs, grinders and other creative tools.

The plant.   




    The leaf  

In the past six months, have your patients asked you about medicinal marijuana to treat specific illnesses or conditions?

The Paraphernalia. 

DeepDyve


57%
Yes47/83
43%
No36/83

Leave a comment


Tuesday, June 21, 2022

How exercise, physical therapy help in the fight against cancer |

The BIG C and Physical Therapy

 

Not a week goes by without a patient asking me why an oncology physical therapist isn’t an automatic part of their cancer team from the beginning. They relay frustration about why it “took so long” for them to be referred to a specialist. Severe muscle loss seems to be a given. Cancer patients who work with a specialized physical therapist from the start of treatments fare better than those who try to regain strength after treatments leave them exhausted and unmotivated. 

Appropriate, early intervention can help prevent physical decline, reduce inflammation and improve patient outcomes. What’s more, exercise during and after cancer treatments reduces and manages side effects, such as chronic pain, lymphedema severity, fracture risk and decreased balance from neuropathy. Early treatment of these issues can also reduce the financial burden of patients, insurance payers and hospital systems. Cancer patients should request physical therapy before, during and after treatments.

Research shows that tailored exercise and physical fitness also can improve the length and quality of life for people diagnosed with cancer. The American Cancer Society recommends physical therapy to improve function, reduce risk of recurrence and improve cancer survival. Ginsburg was diagnosed with pancreatic cancer in 2009; the vast majority of patients do not survive five years. She lived for another 11. While no one can say for certain how she beat the odds, it is my opinion that exercise played a role. 

Richard Briggs, physical therapist, coined end-of-life exercise as, “rehab in reverse.” The more usual pattern in hospice and an unfamiliar concept for the therapist to apply is that of “rehabilitation in reverse” as identified by Briggs,[29] which includes exploring the process of functional adaptation and occupational engagement on a daily basis. Throughout each phase of decline during the dying process, new or adapted skills and abilities must be learned by the patient, as well as the care givers, to maximize functional independence and safety. The therapist has the knowledge and skill to assess current status; teach appropriate techniques such as transfers, bed mobility and positioning to decrease pain; collaborate with patients on relaxation techniques; adapt activities of daily living and mobility; and instruct in the use of needed equipment. Other team members may provide some basic instruction but the therapist should be consulted for further care. Therapists provide skilled therapy service that achieves the hospice goal of promoting safety, independence, meaning and quality of life, despite the physical and mental decline which is expected.

For example, the physical therapist might have a patient who has a brain tumor and is unsteady. The patient has been walking without a cane, and now the therapist has to teach him how to use a cane and teach family members to assist with balance. Then, a week or two later, the therapist need to fit him with a walker and teach him to use it. A month later, therapist needs to teach transfers from bed to a wheelchair. And one week later, the therapist might be positioning for pressure relief. As the patient’s health is declining, there is always some level of skilled care that the therapists can provide.[3]


What he meant was that appropriate physical therapy helps reduce the risk of falls, fractures and hospitalizations, all too common with frail patients. Physical therapists teach patients about safety, equipment and swelling management when patients are still walking, different guidance when patients become more sedentary and updated recommendations when patients are bed-bound. Studies show that when pain and other symptoms of a terminal illness are managed, people can work and live longer, just like Ginsburg.

REWARDS
While there is great opportunity for more physical therapists to make a difference in the hospice setting, this is clearly an area of practice that is not for everybody. Becoming involved in a family’s grief process can certainly be emotionally draining. But physical therapists with experience in this area of practice overwhelmingly report that the rewards of hospice care are indeed rich.[3]

Says Steve Gudas, “The spirit, the strength, the courage, the resiliency, and the determination that people have toward the end is amazing to witness. And it is a privilege to play a role in the process. It is actually life affirming.”[3]

Adds Nicole Gergich, “It is gratifying to connect with a person at this time in his or her life. We can offer the patient control, independence, and dignity. Yes, it is sad that the person is dying. But if I am the one who can help, Iam glad to have been part of it. It is rewarding and reinforces to me how very important my job is.”[3]

The number of cancer survivors worldwide is growing, with over 15.5 million cancer survivors in the United States alone-a figure expected to double in the coming decades. Cancer survivors face unique health challenges as a result of their cancer diagnosis and the impact of treatments on their physical and mental well-being. For example, cancer survivors often experience declines in physical functioning and quality of life while facing an increased risk of cancer recurrence and all-cause mortality compared with persons without cancer. The 2010 American College of Sports Medicine Roundtable was among the first reports to conclude that cancer survivors could safely engage in enough exercise training to improve physical fitness and restore physical functioning, enhance quality of life, and mitigate cancer-related fatigue.

 Overall findings retained the conclusions that exercise training and testing were generally safe for cancer survivors and that every survivor should "avoid inactivity." Enough evidence was available to conclude that specific doses of aerobic, combined aerobic plus resistance training, and/or resistance training could improve common cancer-related health outcomes, including anxiety, depressive symptoms, fatigue, physical functioning, and health-related quality of life. Implications for other outcomes, such as peripheral neuropathy and cognitive functioning, remain uncertain.




How exercise, physical therapy help in the fight against cancer | The Seattle Times

Monday, June 13, 2022

Startup gets green light to use Apple Watch to track Parkinson's symptoms

Remote monitoring

Software that enables Apple Watch-based tracking of Parkinson’s disease symptoms has received clearance from the Food and Drug Administration, a move that could open doors for its maker as it strives to reach more people living with movement disorders — and potentially, those who haven’t developed them yet.

The StrivePD system uses Apple’s Movement Disorder API to track tremors and dyskinetic symptoms of Parkinson’s from the Apple Watch. The data is all collected in an iPhone application, which allows patients to record their symptoms and keep tabs on medication.

The system has been used to monitor patients since last year at the University of California San Francisco and Mount Sinai, and the company is expanding its work further this year. The new FDA clearance specifically pertains to Rune’s Apple Watch-based symptom tracking capabilities and will make it possible for clinicians to use certain billing codes when reviewing data from the device. It will also allow trial sponsors to use the data as endpoints in studies submitted to regulators.

 StrivePD was developed by Rune Labs, a neurological data startup run by Brian Pepin, a former engineer from Alphabet life science company Verily. The company announced last year that it had raised nearly $23 million to continue to develop its neurology data platform. Also last year, the company launched a partnership with Medtronic to pilot data collection from the company’s Percept​​ PC Deep Brain Stimulation device. The StrivePD platform can integrate data from these devices, making it a kind of one-stop shop for clinicians and clinical trial sponsors who want to review data.

The company didn’t actually need regulatory clearance for how it displays the data to clinicians right now. But Pepin said it’s an important milestone for the company as it seeks to expand its work with pharma and med device companies. He also hopes the news will jumpstart an effort to identify people who have early signs of Parkinson’s.

There are several medical grade devices capable of tracking Parkinson’s symptoms, but using a device already familiar to consumers has many theoretical advantages. Millions of people already own Apple Watches, which could make it easier to recruit trial patients, including people who live in remote places or for whom travel is difficult. And because the device is popular and appeals to consumers, it’s more likely that someone using the tool to monitor symptoms long-term will stick with tracking consistently. The downside is that the Apple Watch and iPhone are relatively expensive devices inaccessible to many people. An Android version of StrivePD is not yet available.

Pepin said that as it becomes possible to track more validated metrics with the Apple Watch, it grows increasingly compelling for its capabilities as well as its wide distribution.

“We’ve invested in this infrastructure around the watch, and we’re able to pretty quickly — as the huge team at Apple that’s working on this stuff is able to spin out new features — take advantage of those,” he said. “And then, I think in some cases, we’ll be able to hopefully do more of what we did here, which is work with Apple to take it to the next step, which is this kind of formal FDA validation.”






Startup gets green light to use Apple Watch to track Parkinson's symptoms

Saturday, June 11, 2022

A Hospital Designed for Patients? - Proto Magazine


A Hospital Designed for Patients?

A

A hospital building can feel timeless. While the halls echo with the sound of ultramodern equipment, basic structural ideas might be familiar to the first practitioners of modern medicine in the 19th century, or to some degree, even the denizens of Europe’s first hospitals in the Middle Ages. Yet each era has left its mark on the way these buildings are built and used—some for the better, some for the worse.

In this day of fiscal restraint for health care, government cutbacks, and pre- authorization there are few new hospitals being built.  Most new construction is for building additions, rehabilitating old structures or adding on a 'Center for Excellence".

The Covid19 pandemic stimulated interest in constructing expandable hospital structures which could be easily increase hospital capacity, and mothballed when not in use. Most current hospital structures were augmeneted by pop up tents, awnings, or trailers for triage and isolating sick from well patients. Other than providing shelter from the sun or rain, they provided little in the way of utilities, water, electric or sterile areas. Many were set up as drive through access to expedite services.













Best Hospitals in America

If you or a family member are looking for the best hospitals a way to judge them is how the staff feels about working there.

Happy staff usually means happy patients.  Staff members usually know what is going on in their institution.  They work on a daily basis with physicians and other professionals.  Word of an incompentent professional spreads quickly amongs staff.

The list below indicates the most satisfied employees at the exceptinal institutions listed below.


Doximity 

Saturday, June 4, 2022

A Musical Vision: High Touch: The Course in Compassion

A Musical Vision: High Touch: The Course in Compassion. published in 2013 (credits to Vincent Deluise M.D. , Professor, Yale Univeersity)

Today it is 2022, nine years later, and nothing has changed.  Despite the outcry all attempts have fallen short.  The system is so complex and there is no one thing that could make it simpler.  Even in the U.K. the N.H.S. struggles with overload.

 

How many times a week do you hear "Healthcare is Broken" ?

We all know how difficult it is to obtain acess to a provider without that 'plastic card' and oh yes, your official government I.D. Once you gain access the guardians at the gate will see you or  refer to the appropriate expertise on the part of the anatomy that is confounding your quality of life.







Today, more people are insured thanks to the Affordable Care Act (Obamacare), however in 2022 there are still a significant number of uninsured citizens.  The number of Americans lacking health insurance ticked up slightly last year, marking the first annual increase in the uninsured rate in nearly a decade, the U.S. Census Bureau reported Tuesday.  The uninsured rate rose from 7.9 percent in 2017 to 8.5 percent last year, amounting to nearly 2 million more uninsured people, as experts said the Trump administration’s efforts to undermine the Affordable Care Act were partly to blame. The tax penallty form being uninsured was removed as well.  

Headquartered in Alexandria, VA, the National Association of Free & Charitable Clinics (NAFC) was founded in 2001 by a group of grassroots medical providers and organizers who recognized that health care was not being provided at a local level to the working poor, uninsured and underinsured in our country in a way that was cost-effective, accessible and affordable.

Many people do not realize that there are approximately 1,400 Free and Charitable Clinics and Charitable Pharmacies throughout the nation who since the 1960s have been filling in the gap for those who “fall through the cracks” in our current health care system. These clinics/pharmacies receive little to no state or federal funding, do not receive HRSA 330 funds and are not Federally Qualified Health Centers or Rural Health Centers. Volunteer doctors, pharmacists and medical students support this effort without compensation.  Often vendors, and medical supply companies donate equipment to be used at these "free clinic".



Sunday, May 29, 2022

Clinical Trials, How to enroll

Patients and providers sometimes exhaust proven treatments for chronic disease and cancer treatments. The Food and Drug Administration approves drugs for human use only after the drug has passed a clinical trial.


BioNews Clinical | BioNews

Wednesday, May 25, 2022

Gov. Newsom signs landmark MICRA modernization bill into law

 Gov. Newsom today signed AB 35 into law, and in doing so put an end to a decades long political battle and ushered in a new era of stability around malpractice liability.

Since California’s landmark medical malpractice reforms – the Medical Injury Compensation Reform Act (MICRA) – were enacted almost 50 years ago, they have successfully struck a balance between compensatory justice for injured patients while maintaining an overall health care system that is accessible and affordable for Californians.

Since that time, California’s physician and provider communities have repeatedly defended MICRA through expensive battles at the ballot, in the courtroom and in the legislature.

This year, we were again facing another costly initiative battle. The so-called Fairness for Injured Patients Act, which had qualified for the November 2022 ballot, would have obliterated existing safeguards for out-of-control medical lawsuits and would have resulted in skyrocketing health care costs. This act demanded that patients who are injured have the right to seek compensation from alleged providers who 'injured' them. The original MICRA act of thee1970s limited compensation to $250,000.

But for the first time in a generation, we were met with an opportunity to achieve a meaningful consensus between competing interests through a revised framework that could protect both the rights of injured patients while keeping MICRA’s essential guardrails solidly in place for patients and providers alike.




“With today’s signing of AB 35, we have achieved what few thought was possible,” said California Medical Association President Robert E. Wailes, M.D 




AB 35 passed through the California Legislature with nearly unanimous support, demonstrating broad bipartisan support. As part of the landmark agreement reflected in AB 35, proponents of the Fairness for Injured Patients Act have withdrawn the initiative. The initiative cannot be returned to the November 2022 ballot.

California’s new modernized MICRA statutes will provide predictability and affordability of medical liability insurance rates for decades to come, while protecting existing safeguards against skyrocketing health care costs. It will also bring greater accountability, patient safety and trust by making it possible for physicians and patients to have a full and open conversation after an unforeseen outcome. 

Under the modernized MICRA law reflected in AB 35, which will go into effect on January 1, 2023, the underlying principles of MICRA were preserved – ensuring access to care and protecting our health care delivery system from runaway costs. Important guardrails of MICRA will continue unchanged, including advance notice of a claim, the one-year statute of limitations to file a case, the option of binding arbitration, early offer of proof for making punitive damage allegations and allowing other sources of compensation to be considered in award determinations. Furthermore, a new provision has been added to the law that protects expression of sympathy by a health care provider to an injured patient and their family, allowing physicians to express empathy, benevolence and even statements of fault after an unforeseen outcome without fear that such statements or gestures will be used against them.

The element that has garnered the most interest surrounds changes to the limit on non-economic damages in medical malpractice cases, which has been $250k since 1975. As opposed to the ballot measure, which would have effectively eliminated the cap on non-economic damages entirely, under the agreement:

Cases not involving a patient death will have a limit of $350k on the effective date of January 1, 2023, with an incremental increase over the next 10 years to $750k and a 2.0% annual inflationary adjustment thereafter.
Cases involving a patient death will have a limit of $500k on the effective date of January 1, 2023, with an incremental increase over the next 10 years to $1 million and a 2.0% annual inflationary adjustment thereafter.
Other critical MICRA guardrails that will remain in place with modest updates include the ability to pay awards of future damages over time and limits on plaintiff's attorney's contingency fees. CMA has prepared a publicly available fact sheet that provides additional details on this important legislation.
“CMA is proud to have been part of this landmark achievement for the benefit of all Californians,” said Dr. Wailes. “We look forward to a new era of long-term stability around MICRA that will allow California’s physician and provider communities to focus on other ways to improve access to care and public health for all Californians.



















Sunday, May 1, 2022

Digital Health News - Digital Salutem




Digital Health came upon the scene in 2005, with a nationwide effort to transform health care with  digital transformation. Anyone practicing medicine would not recognize how healthcare would transform between 20012 and today, 2022. 

Scientific peer reviewed journals in medicine have a plethora of articles documenting the efficacy and efficiency for better cost effective medicine and evidence based information to sustain it's utility and further development, and proof of ROI.

In 2020 as the COVID 19 pandemic exploded across the globe digital health allowed for our health system to not implode, even when stretched to overcapacity.

Computing power allowed for data analytics, tracking and reporting of the pandemic.

The World Health Organization and Johns Hopkins University produced daily maps and statistics individualized to state, and nationality of the pandemic as it progressed. These were available on the internet in real time.


Daily Moving Average (in real time)


3 new trends in eHealth

Here are 3 recent innovations or trends in eHealth:

Virtual clinics: Virtual clinics let you see an expert doctor remotely at home on your computer instead of having to travel outside your home (or waiting in line). The idea behind this type of solution is that doctors can make appointments from anywhere in the world instead of having doctors based around your area (which means you can get more high quality health care). This is great for consumers because it allows them to see specialists or other specialists outside their area (for example as part of an emergency room) but less so for patients because remote care requires trained staff who are highly specialized and often expensive to get hold of.

Remote Clinical Care: A lot of people simply do not want or need access to an actual doctor when they need help with their health issues, especially if they live far away from an actual hospital (which is why there are so many virtual clinics available). But if we combine remote clinical care with virtual clinics then you can get high quality accurate care anywhere any time, be it at home or online, without needing access to an actual doctor at all! This allows patients who might not feel comfortable calling out sick or going into hospitals on their own but still need help with something like diabetes or heart disease can go online and see someone who has experience treating those issues remotely rather than having them deal directly with doctors at hospitals near them.

Virtual medical centers: are used to provide services easier and more cost-effectively when you call. A virtual clinic is a planned contact by the Healthcare Professional Responsible for Care with a patient for the purposes of clinical consultation, advice and treatment planning. It has been found to increase patient access to healthcare services, enhance health outcomes, improve patient experience and make optimal use of scarce medical resources.

Digital Health has made possible Precision Medicine whereby treatments can be specifically tailored to individual patients. 

The University of California San Diego (as well as many others) has developed a Digital Health Lab,  founded by Professor Edward J. Wang as a joint research laboratory of UCSD Design Lab and the Electrical & Computer Engineering department of Jacobs School of Engineering.

































Digital Health News - Digital Salutem




Saturday, February 19, 2022

Perspectives from the Frontline of the Fight for Public Health: A Live Q...


Leana Wen likes to say: “Public health saved your life today. You just don’t know it.” Join the conversation as she describes her experience on the frontlines of this critical—and often invisible—field.

Tuesday, February 15, 2022

FAKE NEWS ? Psilocybin treatment for major depression effective for up to a year for most patients - ScienceBlog.com

DISCLAIMER: 

This information is neither a recommendation nor advice for treatment.  The reader is cautioned to consult with their personal physician prior to using psilocybin for the treatment of any medical or psychiatric condition.

For readers who wish to dive deeper into the subject, read this




Previous studies by Johns Hopkins Medicine researchers showed that psychedelic treatment with psilocybin relieved major depressive disorder symptoms in adults for up to a month. Now, in a follow-up study of those participants, the researchers report that the substantial antidepressant effects of psilocybin-assisted therapy, given with supportive psychotherapy, may last at least a year for some patients.

A compound found in so-called magic mushrooms, psilocybin produces visual and auditory hallucinations and profound changes in consciousness over a few hours after ingestion. In 2016, Johns Hopkins Medicine researchers first reported that treatment with psilocybin under psychologically supported conditions significantly relieved existential anxiety and depression in people with a life-threatening cancer diagnosis.A report on the new study was published on Feb. 15, 2022 in the Journal of Psychopharmacology.

The study was done under carefully controlled scientific studies by professional monitors who sat side-by-side with the patient.





Magic Mushrooms have been used for many decades by drug users. It is a powerful psychedelic drug produced by many different fungi, and ingested orally. Like LSD it has been proposed for treatment (Timothy Leary). Leary earned a PhD at U.C. Berkeley and was a psychologist at Harvard University and famous for a speech given "Turn up, turn in, and turn out ". 


John Lennon and Yoko Ono were patrons of Leary, Lennon composed the song "Come Together" after meeting Leary.

L-R John Lennon, Timothy Leary, Yoko Ono

 Johns Hopkins is one of the sites of a national multisite randomized, placebo-controlled trial of psilocybin for major depressive disorder. 

The study was supported by philanthropic donors The Steven and Alexandra Cohen Foundation, Tim Ferriss, Matt Mullenweg, Craig Nerenberg, Blake Mycoskie, and Dave Morin; as well as by grants from the Riverstyx Foundation and the National Institute on Drug Abuse (T32DA007209, R01DA003889, K23DA035915).




Psilocybin treatment for major depression effective for up to a year for most patients - ScienceBlog.com