HHS’s $240M ACA Funding Awards Support Primary Health Access

Not quite as 'sexy' is what the affordable care act is funding in regard to helping eliminate health care professional shortage.   Adding 30 million uninsured to the ranks of 'insured' increases the shortfall in regard to provider access.

“The most critical step in connecting people to quality health care is a primary care provider,” says Secretary Burwell within a press release. “These awards provide financial support directly to health professionals, including physicians, registered nurses, and physician assistants, to help individuals – particularly the 17.6 million uninsured who have recently gained coverage – find the primary care services they need,” Burwell adds.

According to HHS, over 9,600 NHSC primary care medical, dental, nursing and behavioral and mental health practitioners provide “culturally competent care to millions of medically underserved people.” Over 2,000 NURSE Corps nurses are working to strengthen care access, the organization maintains. The bipartisan Medicare Access and CHIP Reauthorization Act, signed into law by President Barack Obama last April, allows for a two-year NHSC funding extension, explains HHS.

“These awards not only strengthen our primary health care workforce, but increase access to primary care in urban, rural and frontier locations nationwide,” adds Jim Macrae, Acting Administrator of the Health Resources and Services Administration (HRSA). “Collectively, these programs are serving millions of Americans who rely on the National Health Service Corps and NURSE Corps clinicians for essential health care services,” says Macrae.

A financial breakdown regarding the awards and the type of support they intend to offer is as follows:

• National Health Service Corps Scholarship Program: 200 new awards at $39 million to provide students studying medicine, dentistry, or pursing education as a nurse-midwife, physician assistant, or nurse practitioner in exchange for the delivery of primary health care services in areas where need is “greatest”
• National Health Service Corps Loan Repayment Program: nearly 3,000 new awards at nearly $126 million granted to fully trained primary care clinicians in exchange for providing primary health care services where need is “greatest”
• National Health Service Corps Students to Service Loan Repayment Program: nearly 100 new awards at over $11 million to provide loan repayment assistance to allopathic and osteopathic medical students nearing graduation in return for their completion of a primary care residency and work within rural and urban areas of “greatest” need
• NURSE Corps Scholarship Program: over 250 new awards at over $23 million granted to nursing students in exchange for a minimum two-year work agreement within a facility experiencing “critical shortages”
• NURSE Corps Loan Repayment Program: over 600 awards at almost $40 million to offer nurses loan repayment assistance in exchange for a commitment to serve at least 2 years at a healthcare facility with a “critical” nurse shortage or as a faculty member at an accredited nursing school
• Faculty Loan Repayment Program: over $1 million for 21 new awards to health professions educators in exchange for serving as a faculty member in an accredited, eligible health professions school
• Native Hawaiian Health Scholarship Program: nearly $800,000 to provide 9 new awards to Native Hawaiian healthcare professionals

Regarding such awards, it is perhaps unclear at this time what primary emotional, financial, professional, educational, and personal challenges students and healthcare professionals will face working in areas where there are noted staffing shortages and dire “critical” need situations. It is hopeful the student completion and retention rate, for instance, will remain steady. Nursing faculty – as well as other STEM-based faculty members – are now facing “the most severe” shortages within entire educational institutions, in turn threatening the collective quality of the nursing workforce. Will awards such as these help the healthcare industry thrive? Perhaps large sums of money placed on the table for loan repayments and the like will mean only the strongest survive, at least with heavier wallets.

The United States Department of Health and Human Services (HHS) awarded over $240 million this week – including nearly $176 million in Affordable Care Act (ACA) funding – to strengthen primary healthcare accessibility. Confirms HHS Secretary, Sylvia M. Burwell, funding will support the National Health Service Corps (NHSC) and NURSE Corps scholarship and loan repayment programs.



HHS’s $240M ACA Funding Awards Support Primary Health Access

New study shows marijuana users have low blood flow to the brain

As the U.S. races to legalize marijuana for medicinal and recreational use, a new, large scale brain imaging study gives reason for caution. Published in the Journal of Alzheimer's Disease, researchers using single photon emission computed tomography (SPECT), a sophisticated imaging study that evaluates blood flow and activity patterns, demonstrated abnormally low blood flow in virtually every area of the brain studies in nearly 1,000 marijuana compared to healthy controls, including areas known to be affected by Alzheimer's pathology such as the hippocampus.

Hippocampus, the brain's key memory and learning center, has the lowest blood flow in marijuana users suggesting higher vulnerability to Alzheimer's. As the U.S. races to legalize marijuana for medicinal and recreational use, a new, large scale brain imaging study gives reason for caution. Published in the Journal of Alzheimer's Disease, researchers using single photon emission computed tomography (SPECT), a sophisticated imaging study that evaluates blood flow and activity patterns, demonstrated abnormally low blood flow in virtually every area of the brain studies in nearly 1,000 marijuana compared to healthy controls, including areas known to be affected by Alzheimer's pathology such as the hippocampus.

All datawere obtained for analysis from a large multisite database, involving 26,268 patients who came for evaluation of complex, treatment resistant issues to one of nine outpatient neuropsychiatric clinics across the United States (Newport Beach, Costa Mesa, Fairfield, and Brisbane, CA, Tacoma and Bellevue, WA, Reston, VA, Atlanta, GA and New York, NY) between 1995-2015. Of these, 982 current or former marijuana users had brain SPECT at rest and during a mental concentration task compared to almost 100 healhty controls. Predictive analytics with discriminant analysis was done to determine if brain SPECT regions can distinguish marijuana user brains from controls brain. Low blood flow in the hippocampus in marijuana users reliably distinguished marijuana users from controls. The right hippocampus during a concentration task was the single most predictive region in distinguishing marijuana users from their normal counterparts. Marijuana use is thought to interfere with memory formation by inhibiting activity in this part of the brain.

According to one of the co-authors on the study Elisabeth Jorandby, M.D., "As a physician who routinely sees marijuana users, what struck me was not only the global reduction in blood flow in the marijuana users brains , but that the hippocampus was the most affected region due to its role in memory and Alzheimer's disease. Our research has proven that marijuana users have lower cerebral blood flow than non-users. Second, the most predictive region separating these two groups is low blood flow in the hippocampus on concentration brain SPECT imaging. This work suggests that marijuana use has damaging influences in the brain – particularly regions important in memory and learning and known to be affected by Alzheimer's."

Dr. George Perry, editor in chief of the Journal of Alzheimer's Disease said, "Open use of marijuana, through legalization, will reveal the wide range of marijuana's benefits and threats to human health. This study indicates troubling effects on the hippocampus that may be the harbingers of brain damage."

According to Daniel Amen, M.D., Founder of Amen Clinics, "Our research demonstrates that marijuana can have significant negative effects on brain function. The media has given the general impression that marijuana is a safe recreational drug, this research directly challenges that notion. In another new study just released, researchers showed that marijuana use tripled the risk of psychosis. Caution is clearly in order."

 










New study shows marijuana users have low blood flow to the brain

Starting age of marijuana use may have long-term effects on brain development

Contrasting Brain Scans of Marijuana Usage.
Divergent patterns in overlapping areas of anterior prefrontal cortex. Credit: Center for BrainHealth

The age at which an adolescent begins using marijuana may affect typical brain development, according to researchers at the Center for BrainHealth at The University of Texas at Dallas. In a paper recently published in Developmental Cognitive Neuroscience, scientists describe how marijuana use, and the age at which use is initiated, may adversely alter brain structures that underlie higher order thinking.

Findings show study participants who began using marijuana at the age of 16 or younger demonstrated brain variations that indicate arrested brain development in the prefrontal cortex, the part of the brain responsible for judgment, reasoning and complex thinking. Individuals who started using marijuana after age 16 showed the opposite effect and demonstrated signs of accelerated brain aging.

"Science has shown us that changes in the brain occurring during adolescence are complex. Our findings suggest that the timing of cannabis use can result in very disparate patterns of effects," explained Francesca Filbey, Ph.D., principal investigator and Bert Moore Chair of Behavioral and Brain Sciences at the Center for BrainHealth. "Not only did age of use impact the brain changes but the amount of cannabis used also influenced the extent of altered brain maturation."

The research team analyzed MRI scans of 42 heavy marijuana users; twenty participants were categorized as early onset users with a mean age of 13.18 and 22 were labeled as late onset users with a mean age of 16.9. According to self-reports, all participants, ages 21-50, began using marijuana during adolescence and continued throughout adulthood, using cannabis at least one time per week.

According to Filbey, in typical adolescent brain development, the brain prunes neurons, which results in reduced cortical thickness and greater gray and white matter contrast. Typical pruning also leads to increased gyrification, which is the addition of wrinkles or folds on the brain's surface. However, in this study, MRI results reveal that the more marijuana early onset users consumed, the greater their cortical thickness, the less gray and white matter contrast, and the less intricate the gyrification, as compared to late onset users. These three indexes indicate that when participants began using marijuana before age 16, the extent of brain alteration was directly proportionate to the number of weekly marijuana use in years and grams consumed. Contrastingly, those who began using marijuana after age 16 showed brain change that would normally manifest later in life: thinner cortical thickness, stronger gray and white matter contrast.

 





Starting age of marijuana use may have long-term effects on brain development

Synthetic cannabinoids versus natural marijuana—a comparison of expectations

An article entitled "Comparison of Outcome Expectancies for Synthetic Cannabinoids and Botanical Marijuana," from The American Journal of Drug and Alcohol Abuse, studied the expected outcomes of both synthetic and natural marijuana.

186 adults who had previously used both synthetic and natural marijuana, as well as 181 who had previously used only botanical marijuana, were surveyed about their expected outcomes of using either type of cannabinoid. The results showed that the expected negative effects were significantly higher for synthetic marijuana than for natural marijuana across both categories of use history.

Despite the more commonly expected negative effects of synthetic cannabinoids, the most cited reasons for using these compounds were wider availability, avoiding a positive drug test, curiosity, perceived legality, and cost.

Authors concluded, "Given growing public acceptance of recreational and medical marijuana, coupled with negative perceptions and increasing regulation of synthetic cannabinoid compounds, botanical marijuana is likely to remain more available and more popular than synthetic cannabinoids.

Journal Article: Comparison of outcome expectancies for synthetic cannabinoids and botanical marijuan

Synthetic cannabinoids versus natural marijuana—a comparison of expectations

Study: Long-term marijuana use changes brain's reward circuit

The recent legalization of marijuana use in California and many other states inspired Health Train Express to publish a series of articles on the use of Marijuana.

Chronic marijuana use disrupts the brain's natural reward processes, according to researchers at the Center for BrainHealth at The University of Texas at Dallas.

 

In many ways this legalization follows the aftermath of 'prohibition' of alcohol many decades ago. History repeats itself.  The course now set before us very much mirrors that of  alcohol.

Caveat emptor !  Beware.  Most of the same caveats apply to marijuana as they do to alcohol. Legalizing marijuana use is in no way any safer than using alcohol.  Addiction and abuse are major dangers.  Government now will tax sales in lieu of the cost of enforcment and the many lives that are imprisoned for minor infractions using marijuana in the past.

Scientific peer reviewed articles have been published in the past decade

This is the first of a number of article on legalization ofMarijuana.

Dependence alters the brain's response to pot paraphernalia

New research from The University of Texas at Dallas demonstrates that drug paraphernalia triggers the reward areas of the brain differently in dependent and non-dependent marijuana users.
 

The study, published July 1 in Drug and Alcohol Dependence, demonstrated that different areas of the brain activated when dependent and non-dependent users were exposed to drug-related cues.

The 2012 National Survey on Drug Use and Health shows marijuana is the most widely used illicit drug in the United States. According to a 2013 survey from the Pew Research Center, 48 percent of Americans ages 18 and older have tried marijuana. The National Institute on Drug Abuse states that 9 percent of daily users will become dependent on marijuana.

"We know that people have a hard time staying abstinent because seeing cues for the drug use triggers this intense desire to seek out the drugs," said Dr. Francesca Filbey, lead author of the study and professor at the Center for BrainHealth in the School of Behavioral and Brain Sciences. "That's a clinically validated phenomenon and behavioral studies have also shown this to be the case. What we didn't know was what was driving those effects in the brain."

To find this effect, Filbey and colleagues conducted brain-imaging scans, called functional magnetic resonance imaging (fMRI), on 71 participants who regularly used marijuana. Just more than half of those were classified as dependent users. While being scanned, the participants were given either a used marijuana pipe or a pencil of approximately the same size that they could see and feel.Marijuana has been shown to have some therapeutic effects

Study: Long-term marijuana use changes brain's reward circuit

Living in Japan vs living in U.S.A.

SHORTER LIFE SPANS, MORE CHRONIC ILLNESS

LONGER LIFE SPANS  LESS CHRONIC ILLNESS

SEE  WHY BY CLICKING HERE, OR BELOW

Living in Japan vs Living in the U.S.A.

Nevada woman dies of superbug resistant to all available US antibiotics

Is this an example of another growing trend how mother nature controls the destiny of earth.

Biology teaches us how biological systems control their own growth based upon available resources and disposal of waste products.

Are we synchronized with earth's biome ?  Are some politicians ignorant or uninformed about how basic laws of nature work ?  Are business interests and corporations more than insensitive about climate change, pollution and the dangers of extracting earth's minerals and carbon sources for energy ?

This "superbug" is another example of signs that humanity may self-extinguish in the next 100 years, as poverty increases in the developed nations with growing disparities between wealth and poor even in highly developed nations.

The superbugs are winning the battle against us

SoundCloud Audio

Witness major refugee and forced emigration events increasing during the last ten years. Populations are risking certain death to escape inhospitable political regimes, famine.

Climate change due to known and unknown cycles plus increased waste with carbon cycle disruption. Ocean rise, coupled with intensifying meteorologic events, tornadoes, hurricanes, cyclones, disrupted weather cycles and extreme temperature variations.

Past events evidenced in archeological  excavations show mass extinctions and migrations for unknown reasons and infectious epidemics. (Vikings, Aztec Indians, and more)

Outbreaks of new diseases, Zika, Ebola,









Nevada woman dies of superbug resistant to all available US antibiotics

The Mighty

Share Your Story or a Loved One's Health Story

How does an illness effect you when another member of the family has a chronic or fatal illness ?

The Mighty offers a platform where you can share  your experiences with others.  The site contains stories of diseases from A-Z.

If you are looking for a village to share your story with others The Mighty is your village. It contains a variety of formats which are educational and even entertaining in light of the serious disorders discussed. The articles are vignettes written by family members and friends of those with these challenges.



from "Wrecking Ball"  by Miley Cyrus





Guidelines for Contributing Writers | The Mighty

Healthcare Stole the American Dream - Here’s How We Get it Back | Dave C...

Healthcare Stole the American Dream - Here’s How We Get it Back |  

 

TEDx Talk

Thanks to Rob Lambert M.D. a pioneer in direct primary care for 

bringing this to my attention.

The middle class is being crushed by skyrocketing healthcare costs, but there are common sense solutions to save it. Dave Chase gives us a non-political road map to solving one of America's biggest problems.

Dave Chase is co-founder of the Health Rosetta and was named one of the most influential people in Digital Health due to his entrepreneurial success, public speaking & writing that recognizes healthcare’s under-performance but contrasts that with a growing cadre of high-performing organizations that have solved healthcare’s toughest challenges. Chase, widely published, co-authored the healthcare Book of the Year in in 2014. Chase was the CEO & Co-founder of Avado, which was acquired by and integrated into WebMD and the most widely used healthcare professional site – Medscape. Before Avado, Chase spent several years outside of healthcare in startups as founder or consulting roles with LiveRez.com, MarketLeader, & WhatCounts. He also played founding & leadership roles in launching two new $1B+ businesses within Microsoft including their $2 billion healthcare platform business. Chase is a father of two great kids/athletes, husband & oxygen-fueled mountain athlete.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

Bay Area Cancer Patient Confronts and Embraces His Right to Die | State of Health | KQED News

Something all patients should know if you live in California and five other states, Oregon,  District of Columbia,Vermont, Washington and California. It is an option in Montana, requiring a terminal illness and a prognosis of less than six months to live.


Many other jurisdictions have similar bills in process.

Other Facts:
The specific method in each state varies, but mainly involves a prescription from a licensed physician approved by the state in which the patient is a resident.

Physician-assisted suicide differs from euthanasia, which is defined as the act of assisting people with their death in order to end their suffering, but without the backing of a controlling legal authority.

In Oregon, "the physician must be a Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) licensed to practice medicine by the Board of Medical Examiners for the State of Oregon. The physician must also be willing to participate in the Act."

In Vermont, "only a doctor of medicine or osteopathy licensed to practice medicine in Washington may write this prescription...A physician, nurse, pharmacist, or other person shall not be under any duty, by law or contract, to participate in the provision of a lethal dose of medication to a patient."

In Washington, "only a doctor of medicine or osteopathy licensed to practice medicine in Washington may write this prescription...participation is entirely voluntary. Health care providers are not required to provide prescriptions or medications to qualified patients."

In California, "An individual seeking to obtain a prescription for an aid-in-dying drug...shall submit two oral requests, a minimum of 15 days apart, and a written request to his or her attending physician. The attending physician shall directly, and not through a designee, receive all three requests required pursuant to this section."

Statistics:

The process of reporting applications and deaths varies by state. Only those states where physician-assisted suicide is mandated by law have a reporting process.

Oregon - Has had a physician-assisted suicide law on the books since 1997. Since its enactment, there has been a steady increase in both prescription recipients and the number of deaths. According to the 2015 Data Summary, as of January 27, 2016, prescriptions have been written for 1,545 people, and 991 patients have died from ingesting the drugs that were legally prescribed to them under the law.

Washington - According to the 2014 annual report, since 2009 prescriptions have been written for 725 people, and there have been 712 reported deaths.

Vermont - Between May 2013 and May 2016, physician reporting forms have been completed for 24 people, according to the Department of Health.

Bay Area Cancer Patient Confronts and Embraces His Right to Die | State of Health | KQED News

Best preventive care? Get vaccines, and don't smoke -

Doctors giving regular checkups will get the most bang for their buck if they advise adults to quit smoking, convince teens to never start, and keep children up to date with immunizations, according to an influential report released Monday by the Bloomington-based HealthPartners Institute.

The research findings, sponsored in part by the U.S. Centers for Disease Control and Prevention, could influence how doctors across the country conduct thousands of regular patient visits each year.

Comparing 28 recommended preventive services, HealthPartne researchers   found that tobacco counseling and pediatric immunizations outranked the others in cost-effectiveness and the potential to save lives.

While all the preventive services are valuable, the reality is that doctors can't do them all in a standard 15-minute office visit, said Dr. George Isham, a senior fellow with the institute.

The study found a particularly strong impact if 90 percent of youth received tobacco prevention counseling — a huge increase from the 20 percent that actually receive it today. "Tobacco use has certainly come down over time, both among adults and youth," said Michael Maciosek, the study's lead author. "Nevertheless, it remains a huge problem compared to other health threats."

HealthPartners' first ranking of preventive services received wide notice when it came out in 2006 — at a time when rising deductibles and copays made patients more sensitive to medical bills and which services they were paying for out of pocket.

Today, preventive services are fully covered by insurers — a requirement of the 2010 Affordable Care Act. But pledges by President-elect Donald Trump and Republican lawmakers to repeal the act could make patients more sensitive to costs again.

"These are all valuable kinds of things, but this research tells us some things are more valuable than others," said Isham, who wrote an editorial that accompanied the research in the Annals of Family Medicine.

Even with preventive services fully covered, the report provides important information to doctors and to health plans in terms of the incentives they provide to doctors, Maciosek said, especially when doctors face time constraints.

Best preventive care? Get vaccines, and don't smoke - StarTribune.com

Congressional plan to repeal and replace the ACA is not clear

Amidst the chaos of electioneering and the run up to the Presidential inauguration, the U.S. Congress is drafting amendments to the affordable care act.  Will it be repeal and replace the Affordable Care Act,  or slice and dice?

Recent summary from the California Medical Association gives some overview of the possible process.

A budget resolution establishing procedural instructions to set up the repeal of the Affordable Care Act (ACA) was introduced in the U.S. Senate on Tuesday. This move by the Senate’s budget committee chairman on the first day of the new Congress has set into motion the GOP promise to repeal the ACA as its first legislative act. The House is expected to vote on the Senate budget resolution shortly after the Senate vote. However, the repeal process could take months, while developing a replacement plan could take years.

Senate Republicans have agreed to use a budget resolution, allowing them to repeal ACA funding without any Democratic votes. Budget resolutions require a simple majority to pass in the Senate, instead of the 60 votes required to clear procedural hurdles. There are 52 Republicans in the 100-seat chamber.

While the Senate budget resolution is a statement of priorities and lays the groundwork for the repeal of the ACA, it does not have the force of law. To repeal the law, the House Energy & Commerce and Ways & Means committees and the Senate Finance Committee need to meet to develop replacement legislation. The Senate plan introduced Tuesday includes a “repeal and replace” strategy that would require passage of two separate bills.

Looming over the whole process of repealing the ACA are the actions of the health care marketplace. Congressional plans to repeal the ACA without a replacement plan in place could result in more uncertainty in an already fragile marketplace, prompting insurers to leave the individual market and creating chaos for the 20 million Americans insured through the ACA.

In addition to working on a replacement plan, Congress must also act on a handful of health care programs before they expire, including the Children's Health Insurance Program; Prescription Drug User Fee Act; Medical Device User Fee and Modernization Act; and the Veterans' Access, Choice and Accountability Act.

The California Medical Association (CMA) is closely following these issues as they play out in Congress and will be actively engaged in shaping the future of health care reform at the national level. CMA will work to ensure that any resulting legislation will benefit the patients and physicians in California and the nation as a whole. We will also work to keep you up-to-date on any breaking news from the nation’s capital.

Below are the principles that will guide CMA’s advocacy on health care reform.

1. Ensure Californians do not lose coverage or access to care.
2. Protect the billions in current state and federal health care funding.
3. Ensure appropriate and broad-based financing.
4. Advocate for patient choice of physicians, health plans and coverage through private contracting, health savings accounts, health plans and state and federal government programs.
5. Continue tax policies and subsidies that help low-income patients afford coverage.
6. Maintain the insurance industry reforms that protect physicians and patients.

Contact: Elizabeth McNeil, (800) 786-4262 or emcneil@cmanet.org.

Keywords:

• ACA
 
• Affordable Care Act
 
• Affordable Care Act (ACA) Repeal
 
• Federal Legislation
 
• Federal Legislative Advocacy

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