ARE YOU A STEM CELL TOURIST ?

Stem cell tourism is a term recently coined to describe a growing practice among patients to pay large sums of money to private clinics for often unproven stem cell therapies. Patients can be desperate because conventional medicine has failed to provide a solution for their particular condition. For diseases affecting children, emotions may run particularly high: the children themselves cannot make properly informed decisions, so parents face the additional conflict of wanting the best for them while, at the same time, having to protect them from undue risk. Advertisements for these clinics, often outside the patient’s own country, claim that stem cell treatment can benefit or cure complaints ranging from diabetes, stroke, paralysis caused by spinal cord injury, cerebral palsy, and Lou Gehrig’s disease (ALS), to wrinkles in the skin and age-related hair loss in men.

Potential Risks of Stem Cell Therapies
Uta Kunter, Jürgen Floege, in Regenerative Nephrology, 2011

Stem cell therapies are very likely to have a major impact on regenerative medicine, but for them to succeed we need to be aware of their specific challenges to avoid setbacks as experienced in the first gene therapy trials. In stem cell therapies, just as in gene therapy, malignancies are a major concern. Other concerns relate to contamination of cell preparations and unwanted formation of ectopic tissue (maldifferentiation), but also to the validity of experimental results, e.g. stem cell markers and heterogeneity of stem cell preparations. Consequently, this chapter will address both the medical safety aspects of stem cell therapies and the scientific safety of stem cell-related data. In reflection of the current literature on stem cell therapies in nephrology, the main focus here is on mesenchymal stem cells (MSCs) and other adult bone marrow preparations. However, with rapid developments in the field, safety aspects concerning stem cells other than MSCs may gain importance in the near future and therefore will be mentioned throughout this chapter.

Although there is some progress using stem cells (MSC) in animals, human clinical research has many ethical issues. Questions have arisen about the safety of stem cell transplantation.  There are those who are against 'letting the genie out of the bottle". Concerns regarding maldifferentiation, cancer, and ectopic tumor development have been raised. The Federal government banned the use of Federal money to fund research with HESCs (Human embryonic stem cells)
Ethical concerns included the definition of human life and the pluripotent nature of embryonic stem cells.

There are no FDA guidelines regarding stem cell usage. Neither have there been any documented regulations as to the preparation, indications, side effects, dosing, adverse reactions.  The typical label which accompanies all FDA approved medications provide that type of information for medications you purchase at your pharmacy.

Currently, the only stem cell therapies approved by the FDA use cells from bone marrow or cord blood to treat cancers of the blood and bone marrow. But doctors in the Cell Surgical Network have moved ahead with using cells for autoimmune, neurologic, and other serious conditions.

If you are interested in the current network of private and commercial stem cell doctors or clinics refer to the Cell Surgical Network. Health Train Express advises extreme caution in choosing this option.  Many of these stem cell doctors are no longer offering this treatment as a result of a court action with a permanent injunction regarding these sources of stem cell treatments. There is also a monograph by Dr. Elliottt Lander and Dr. Mark Berman on the history of Stem Cell treatments along with several anecdotal stories.

FDA Regulation of Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/P's) Product List

If readers wish to learn more and read peer-reviewed scientific articles can be found at PubMed or Google Scholar

Important HIPAA Update: New Penalties - Clinics get $85,000 Fines for NOT Releasing Data to Patients

Important HIPAA updates can have a far-reaching impact. Learn how to stay compliant. 

Yes Virginia HIPAA defines what is secret and confidential and also what must be transparent to the patient.  It is their data!

Everyone thinks of HIPAA as a security lock-down law, and indeed it is: a major part of HIPAA regulations is about the data holder’s responsibility to be careful with it. There have been huge penalties for allowing data leaks.  

Fewer people realize that HIPAA regulations have also always included a “right of access” - here’s that page on the HHS website. It means that patients are allowed to request copies of their records, and providers must comply. This has always been true, but there’s an important change: in 2019, the government settled its first two major cases (with big fines) where a patient asked for their data and the provider dragged its feet.

The right of access has never been enforced. But that has changed.

How would you like an $85,000 fine? Plus a year-long corrective plan?  That’s what Korunda Medical (in Florida) agreed to in December. It’s also what Bayfront Medical settled for in September. For deeper information about both settlements, see this blog post by Deven McGraw, who many believe is the world’s leading HIPAA authority. Her company Ciitizen’s scorecard project showed that half of the providers were in violation.

Each $85,000 fine was for a single violation - a single (but persistent) failure to honor one patient’s legal request.

If they ask for it by email, you must deliver it by email

Another commonly misunderstood issue is whether a patient can request that their information be delivered by email. Commonly, providers (even their HIPAA compliance people) refuse to do this, because ordinary email is unsecured and hackable. But if the patient requests it by email, the provider must comply.

This is so widely misunderstood that it’s now on a Frequently Asked Questions page. Here’s a screen capture Dec 17 from HIPAA FAQ #570, on the Office for Civil Rights website: 

You’re not allowed to say “Regardless of the law, we don’t do that.”

Unfortunately, if the law says you have to do it, you’re not allowed to have a “policy” that says “not me.” That’s like saying “My policy is that I do get to steal your car.”

The community created a Google Doc containing those screen captures and a slew of additional information: bit.ly/HIPAAemail with links to the above and numerous other details. 

Be informed. Stay out of trouble. Save money.

You can imagine that in both of those cases that ended with $85,000 fines, the provider incurred far greater costs in the months of dealing with investigators, not to mention the impact on their reputation in the local community of all the resulting news coverage. 

Avoiding this is straightforward - not necessarily trivial, but not complicated: know the law. Study HIPAA’s “right of access,” look at the links in that google doc, and do the right thing. It’s a lot easier than coping with the consequences of getting caught. And it’s the right thing to do for the patients.

Want to know more about HIPAA and other regulations in relation to patient communication? Read our free guide, "Become a Text and Email Compliance Guru."

Learn how to become a text and email compliance Guru

HIPAA Update: New Penalties - Clinics get $85,000 Fines for NOT Releasing Data to Patients:

More drugmakers hike U.S. prices as new year begins

 Drugmakers including Bristol-Myers Squibb Co (BMY.N), Gilead Sciences Inc (GILD.O), and Biogen Inc (BIIB.O) hiked U.S. list prices on more than 50 drugs on Wednesday, bringing total New Year’s Day drug price increases to more than 250, according to data analyzed by healthcare research firm 3 Axis Advisors. 


Reuters reported on Tuesday that drugmakers including Pfizer Inc (PFE.N), GlaxoSmithKline PLC (GSK.L) and Sanofi SA (SASY.PA) were planning to increase prices on more than 200 drugs in the United States on Jan. 1.

Nearly all of the price increases are below 10% and the median price increase is around 5%, according to 3 Axis.

More early year price increases could still be announced.

Soaring U.S. prescription drug prices are expected to again be a central issue in the presidential election. President Donald Trump, who made bringing them down a core pledge of his 2016 campaign, is running for re-election in 2020.

Many branded drugmakers have pledged to keep their U.S. list price increases below 10% a year, under pressure from politicians and patients.

The United States, which leaves drug pricing to market competition, has higher prices than in other countries where governments directly or indirectly control the costs, making it the world’s most lucrative market for manufacturers.  Drugmakers often negotiate rebates on their list prices in exchange for favorable treatment from healthcare payers. As a result, health insurers and patients rarely pay the full list price of a drug.  Bristol-Myers said in a statement it will not raise list prices on its drugs by more than 6% this year.  The drugmaker raised the price on 10 drugs on Wednesday, including 1.5% price hikes on cancer immunotherapies Opdivo and Yervoy and a 6% increase on its blood thinner Eliquis, all of which bring in billions of dollars in revenue annually.  Gilead raised prices on more than 15 drugs including HIV treatments Biktarvy and Truvada less than 5%, according to 3 Axis. Biogen price increases included a 6% price hike on multiple sclerosis treatment Tecfidera, according to 3 Axis.

More drugmakers hike U.S. prices as new year begins - Reuters:

A THROAT SWAB FOR $ 25,000 . ?

Good morning, it's Sunday morning, if you are tired of watching the Trump Impeachment Carnival, have your coffee watching this story. (it is a true story)

Insurance companies are supposed to LOWER healthcare costs by fighting inappropriate price gouging, right? WRONG. Here's why.

The story is all too common. Next time your physician orders a test, image or any service from an outside vendor.

A routine doctor's visit for a sore throat brought more than $28,000 in charges for one woman. In our Bill of the Month partnership with Kaiser Health News and NPR, we take a look at unexpected medical costs. The woman’s visit shows even when insurance does cover medical charges, costs can still skyrocket in the long run. David Begnaud reports, and Kaiser Health News editor-in-chief Dr. Elisabeth Rosenthal joins “CBS This Morning” to discuss the findings.

1. Ask how much it will cost

2. Don't believe what he says, because he does not know. If he refers you to one of his staff ask him/her.

3. Tell the staff member to order it from an in-network provider.

The Latest Breaking News about Physician Burnout

Physician burnout: Which medical specialties feel the most stress?

An online survey of doctors finds an overall physician burnout rate of 42%, which is down from 46% five years ago. Three new entries in the top six specialties with the highest rates of burnout compared with last year’s edition of the survey provide medical students and residents with new insight into their future careers.

The numbers of physicians who report burnout vary greatly between specialties.

In the Medscape survey, the highest percentage of physician burnout occurred among these medical specialties:

Urology: 54%.
Neurology: 50%.
Nephrology: 49%.
Diabetes and endocrinology: 46%.
Family medicine: 46%.
Radiology: 46%.

The lowest rates of burnout were reported by physicians in these medical specialties:

Public health and preventive medicine: 29%.
Ophthalmology: 30%.
Orthopedics: 34%.
Psychiatry: 35%.
Otolaryngology: 35%.
General surgery: 35%.

These findings correlate well with other studies by the AMA, Mayo Clinic and Stanford.

Reasons for burnout vary among specialties.

Interference with lifestyle and home life.
Long hours
Unrelenting stress
Disappointment with choice of specialty, or mode of practice setting.
Physical or Emotional disturbance.
Medico-legal issues

What has been left out is pre-morbid emotional disturbances, such as bi-polar spectrum disorder, depression, anxiety. The selection of a particular specialty is often secondary or directly attributable to personality type. Social anxiety disorder would lead a physician into a specialty such as a pathology, or anesthesiology.

What is burnout?

Burnout among physicians was measured using the emotional exhaustion and depersonalization scales of the Maslach Burnout Inventory (MBI), a validated questionnaire considered the criterion standard tool for measuring burnout.28, 29, 30, 31 Consistent with convention,10, 32, 33 we considered physicians with a high score on the depersonalization and/or emotional exhaustion subscale of the MBI as having at least one manifestation of professional burnout.28

Concurrent validity of single-item measures of emotional exhaustion and depersonalization in burnout assessment

Although the MBI is the criterion standard for the assessment of burnout,28 its length and expense limit feasibility for use in long surveys addressing multiple content areas or in large population samples. Thus, to allow comparison of burnout between physicians and population controls, we measured burnout in both groups using 2 single-item measures adapted from the full MBI. These 2 items correlated strongly with the emotional exhaustion and depersonalization domains of burnout measured by the full MBI in a sample of more than 10,000 individuals,34, 35 with an area under the receiver operating characteristic curve of 0.94 and 0.93 for emotional exhaustion and depersonalization, respectively, for these single items relative to the full MBI.

Ocam's Razor

The simplest solution is often the correct one.  In this case, 3 out of four times  one criterion yields a correct answer to the question, In this case, depersonalization, The single question with the highest factor loading on the emotional exhaustion (EE) (“I feel burned out from my work”) and depersonalization (DP) (“I have become more callous toward people since I took this job”) 





















More on Physician burnout

Direct Primary Care, More Affordable 'Concierge' Medicine, Is Hard To Scale Up : Shots - Health News : NPR

The model, which gives patients direct access to their doctors and longer appointment times, is proving hard to scale up.

Some people spend $200 a month on the golf course or on a fancy cable TV package, says David Westbrook, a hospital executive in Kansas City, Mo. His splurge? He pays Dr. John Dunlap $133 a month for what he considers exceptional primary care.

Dr. John Dunlap runs a direct primary care practice in Overland Park, Kan., offering patients direct access to him by phone and longer appointment times. The model is similar to concierge medicine.

"I have the resources to spend a little extra money on my health care to my primary care physician relationship," Westbrook says. "Because I have that access — and am very proactive in managing my personal health — I think I'm going to be healthier."

That $133 is in addition to Westbrook's monthly insurance premium, which he still needs to cover whatever Dunlap can't handle in his primary care practice, such as specialist visits, hospital care and more.

For that fee, he has access to "concierge medicine" perks: a long, thorough annual physical exam — lab work included, no waiting room time, same-day appointments. Any other visits during the year cost him $20. His doctor knows him and understands his medical history. If he needs an answer to a question, he can call his doctor's cellphone.

This model is for more affluent people, however, some people will take the extra expense to assure accessibility which has become a major issue for even the insured. Payment for DPC can be made monthly, annually or per visit.  Physicians benefit from less overhead, paperwork, billing, and collections.  Staffing can be greatly reduced not having to use billers, insurance claims, denials all of which increase overhead, time and expense.

For years, Dunlap took insurance and ran a traditional practice. Now he has about 800 patients who pay him monthly fees directly.

More than 1 in 5 wealthy people pay an extra fee for direct access to their doctor, according to a new poll from NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. For low and middle-income people, the rates are less than half that.

David Westbrook, photographed in his home in Kansas City, Mo., is a patient of Dr. John Dunlap. He pays $133 per month and gets what he considers exceptional care.

Barrett Emke for NPR

"There are approximately 1,000 [direct primary care] practices in 48 states serving approximately 300,000 U.S. patients," says Sullivan from Harvard, citing the Direct Primary Care Coalition. There's less known about how many patients receive care in true "concierge" practices, Sullivan says. There are also many patients seen at hybrid practices, which charge an extra fee for some of the same perks these other models offer but also bill your insurance, like a traditional doctor's office.

There's a basic math problem here. If doctors see fewer patients, there would need to be many more primary care doctors practicing in this country for this model to be more widespread. And that's a tall order, says Sullivan.

"We have issues with access to primary care in this country. We don't have enough trainees or enough clinicians choosing primary care," she points out. "To have [providers] suddenly hopping over to this model would continue to probably decrease access for patients to primary care."

How fair or unfair do you think it is that people with higher incomes can get better health care than people with lower incomes?










Direct Primary Care, More Affordable 'Concierge' Medicine, Is Hard To Scale Up : Shots - Health News : NPR:

True or False: Your Patients' Health Data Is Protected by Privacy Rights? Right ?

When you are checking into your doctors' office for the first time, you are handed a HIPAA form. Within that document is legalese describing how your information will be protected....some of the time. Few people read it, skipping to the signature form. Patients skip to the forms about their past and present medical issues

The following is a guest article by Deborah Hsieh, Chief Policy & Strategy Officer at Ciox. 

When most of your patients hear “health data rights,” they likely think of HIPAA, or the long forms they rarely read in their doctors’ offices. What they may take for granted is the protections for health data that covered entities must provide.

The Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996 and is the framework on which health data protection has been constructed. The initial intent of the Act was to support the continuation of health insurance coverage and to ensure the security and confidentiality of patient information/data. The regulation fundamentally acknowledged the value of health data and the need for protection.

Where do health privacy rights start and end?

Despite the almost quarter-century that has passed since HIPAA was first enacted, there is relatively limited awareness of health privacy rights beyond compliance and legal experts. News of Google and Ascension’s partnership in November surprised the general public, including legislators, and perhaps exposed that limited awareness. One element many individuals are unfamiliar with is that the same health data that is protected when held by a covered entity – a healthcare provider, healthcare payer or business associate of one of those parties – is not protected if it is held by anyone else.

Almost 25 years have passed since HIPAA was created.  Since that time there have been many changes, electronic health records, health information exchanges, telehealth, telemedicine, and remote monitoring to mention a few.

Many of the new companies bringing innovations in digital health are not covered entities or business associates, which means patients have no privacy protections for health data obtained by, shared with and/or created with those companies. As digital health companies and applications become more prevalent and consumers share more of their health data through the applications, consumers must understand their health data rights and how their data is being used so they can make informed choices. In addition to that, without defined protections, someone who is not a covered entity or business associate may also not be held accountable for any breaches of privacy in health data. Based on who holds the data, your patients may not have any recourse.

Protections for health data security are just as critical as those for privacy. In December, the Centers for Medicare and Medicaid Services (CMS) closed access to Blue Button 2.0, as a bug in the code “may be causing certain beneficiary protected health information to be inadvertently shared with another beneficiary or the wrong BB2.0 application.” CMS’s Blue Button 2.0 has been a prime example of the potential of application programming interfaces (API) and increased access to and exchange of health data. That an application created and run by the federal government still suffers from security issues should increase attention to and scrutiny of the security capabilities of other applications accessing health data.

Given this complex landscape, what should you do?

Providers, payers and their business associates should ensure they are abreast of current discussions about healthcare data privacy and security. Administrative actions include a proposed regulation by the Office of the National Coordinator for Health Information Technology related to healthcare data interoperability and exchange and plan to revisit HIPAA. The legislature is also increasing its attention to privacy generally, including for healthcare data. There is great potential for increased access and exchange of health data to improve healthcare delivery; however, there should be recognition and mitigation of the potential challenges to privacy and security, as well as thorough patient understanding.

Finally, healthcare stakeholders should be proactive in helping consumers understand the protections, or lack thereof, for their healthcare data. You can create a more positive consumer experience by educating your patients about their rights and the potential consequences of healthcare data sharing choices.

The important thing for patients to know is you have the right to opt-out of interoperability. Your electronic health record would then be inaccessible to other entities other than your physician. In that situation, you are the owner of your medical data and it cannot be released unless you sign a specific waiver to share it.

Twenty or more years have passed since HIPAA went into effect.  It is most likely there will be no improvement.  There will always be bugs, hacks, and phishing for your data.  In today's world, your data is worth a lot of money. Entities will buy it, and resell it.  There are criminal elements and marketing enterprises that are dedicated to creating revenues from your data.







True or False: Your Patients' Health Data Is Protected by Privacy Rights? | Healthcare IT Today:

Study: Medicaid expansion linked to 6 percent decline in opioid overdose deaths | TheHill

 Medicaid expansion was linked to a 6 percent reduction in opioid overdose deaths, according to a new study.

The study in an online version of the Journal of the American Medical Association finds that counties in states that accepted the Medicaid expansion under the Affordable Care Act (ACA) had a 6 percent lower rate of opioid overdose deaths compared to counties in states that did not expand Medicaid.

The study finds the data indicates that Medicaid expansion may have prevented between 1,678 and 8,132 deaths from opioid overdoses between 2015 and 2017. For comparison, there were 82,228 total opioid overdose deaths in that time period, the study states. 

“These findings add to the emerging body of evidence that Medicaid expansion under the ACA may be a critical component of state efforts to address the continuing opioid overdose epidemic in the United States,” the study states.

Graph of Overdose Deaths per 100,000 population

In this nationwide, population-based study of the association of Medicaid expansion under the ACA with county-level rates of opioid overdose mortality, we found empirical support for adopting and sustaining health coverage expansions as a potential tool for reducing opioid overdose deaths in the United States. Consistent with prior analyses16,27 examining Medicaid expansion and mortality from other causes, we found decreased rates of opioid overdose deaths associated with the adoption of Medicaid expansion. In particular, given 82 228 opioid-related deaths from 2015 to 2017 in the 32 states that expanded Medicaid between 2014 and 2016, our findings suggest that these states would have had between 83 906 and 90 360 deaths in the absence of the expansion, implying that Medicaid expansion may have prevented between 1678 and 8132 deaths in these states during those years.

The observed association between Medicaid expansion and decreased total opioid overdose deaths and deaths involving heroin and synthetic opioids other than methadone is likely in part attributable to the ACA’s inclusion of mental health and SUD services as essential health benefits. Expanded Medicaid eligibility has substantially increased access to these services among the low-income population.10,29 Recent evidence demonstrates that compared with non-expansion states, Medicaid expansion states experienced increases in overall prescriptions for, Medicaid-covered prescriptions for, and Medicaid spending on both MOUDs, particularly buprenorphine and naltrexone, and the opioid overdose reversal medication naloxone.6-8,11,14,30,31,35
Geographic Variation in Opioid and Heroin Involved Drug Poisoning Mortality Rates

Introduction
An important barrier to formulating effective policies to address the rapid rise in U.S. fatal overdoses is that the specific drugs involved are frequently not identified on death certificates. This analysis supplies improved estimates of state opioid and heroin involved drug fatality rates in 2014, and changes from 2008 to 2014.

Methods
Reported mortality rates were calculated directly from death certificates and compared to corrected rates that imputed drug involvement when no drug was specified. The analysis took place during 2016–2017.

Results
Nationally, corrected opioid and heroin involved mortality rates were 24% and 22% greater than reported rates. The differences varied across states, with particularly large effects in Pennsylvania, Indiana, and Louisiana. Growth in corrected opioid mortality rates, from 2008 to 2014, was virtually the same as reported increases (2.5 deaths per 100,000 people) whereas changes in corrected heroin death rates exceeded reported increases (2.7 vs 2.3 per 100,000). Without corrections, opioid mortality rate changes were considerably understated in Pennsylvania, Indiana, New Jersey, and Arizona, but dramatically overestimated in South Carolina, New Mexico, Ohio, Connecticut, Florida, and Kentucky. Increases in heroin death rates were understated in most states, and by large amounts in Pennsylvania, Indiana, New Jersey, Louisiana, and Alabama.

Conclusions
The correction procedures developed here supply a more accurate understanding of geographic differences in drug poisonings and supply important information to policymakers attempting to reduce or slow the increase in fatal drug overdoses.

The observed association between Medicaid expansion and decreased total opioid overdose deaths and deaths involving heroin and synthetic opioids other than methadone is likely in part attributable to the ACA’s inclusion of mental health and SUD services as essential health benefits. Expanded Medicaid eligibility has substantially increased access to these services among the low-income population.10,29 Recent evidence demonstrates that compared with non-expansion states, Medicaid expansion states experienced increases in overall prescriptions for, Medicaid-covered prescriptions for, and Medicaid spending on both MOUDs, particularly buprenorphine and naltrexone, and the opioid overdose reversal medication naloxone.6-8,11,14,30,31,35






Study: Medicaid expansion linked to a 6 percent decline in opioid overdose deaths | TheHill:

The Dark Side of Health Trackers

Say you’ve received a brand-new Fitbit for Christmas to get you started in tracking your exercise routine and reach your fitness goals. Great! However, there might be more going on behind the scenes of you keeping fit with the help of technology than meets the eye...

Just like the Jedi Order's Light and Dark side of The Force, health trackers also have contrasting sides akin to the Sith and the Jedi, and you might have unintentionally signed a pact with the dark side already… In hindsight, it might have been a better idea to have asked for a LEGO Millennium Falcon instead...

The Medical Futurist, we’re great fans of wearables (or health trackers) that help you make more informed decisions when it comes to your health. However, we can’t stay indifferent to the potential risks which using these devices entail such as individual tracking, inaccuracies and even supplementing harmful behaviors.

If you were oblivious about the flip side of the health-tracking industry, then join us as we explore the lesser-known, darker side of wearables.

Cyborgs under surveillance

While fitness trackers are practically turning us into cyborgs, they are also increasingly allowing us to be tracked in ways we might not be aware of. In an eye-opening piece published last December, the New York Times showed how, by using only a fraction of location data obtained from a location data company mining that information from various apps, they could track and identify people from military officials to Hollywood stars. A singer whose activities they tracked couldn’t even name the app that might have collected the data used, even though she was careful about limiting how she shared her location.

Find the dots, connect the dots. Even if the data is anonymized, in today's world AI and algorithms will compare data from one source with another, and derive a statistical likelihood that the data is yours.

If you consider that the global number of connected wearable devices is expected to amount to over 1.1 billion in 2022, then you are very likely to be among the owner of such a device that might be giving away your location history to potentially unscrupulous third parties...

For tighter control over the data collected, the same authors of the New York Times article shared 3 quick steps that you can take. These include manually stopping location tracking by apps, disabling mobile ad ID and switching off location sharing in your Google account. Where applicable, you can also set up two-factor authentication on your accounts.

If you’re using a fitness tracker to better monitor and/or attend to a medical condition, you should do so under the guidance of a medical professional. Moreover, any aberrant results you might come across should be cross-checked with a professional.

Be sure to check out our Health Sensors & Trackers articles for more in-depth discussions and reviews of the latest devices.

 The Dark Side of Health Trackers | LinkedIn

Leading Health Indicators

The Ten Year Plan

Unknown to many there are federal guidelines as to how federal funds are spent. The National Academies of Medicine advisory committee released their list of priority areas for medicine whose goals are for 2030.  The NAM has provided this list since 1979.

Beginning in 1979 and in each subsequent decade, the U.S. Department of Health and Human Services (HHS) has overseen the Healthy People initiative to set national goals and objectives for health promotion and disease prevention. The Healthy People effort also informs public health planning and measurement at the state and local levels.

The HHS Office of the Assistant Secretary for Health charged The National Academies of Sciences, Engineering, and Medicine with assisting in the development of Leading Health Indicators (LHIs) for Healthy People 2030. To accomplish this task, the National Academies convened a consensus committee to provide advice on two components of the Healthy People 2030 effort. The committee was asked to develop (1) recommendations regarding the criteria for selecting LHIs and (2) a slate of LHIs that will serve as options for the Healthy People Federal Interagency Workgroup to consider as they develop the final criteria and set of LHIs for Healthy People 2030. The committee also could identify gaps and recommend new objectives for LHI consideration that meet the core objective criteria. The report Criteria for Selecting the Leading Health Indicators, released in August 2019, responded to part 1 of the charge. The committee’s response to part 2 is found in the present report.

Download the report here.

The Health 202: Here are President Trump's top five health-care whoppers - The Washington Post

The top one goes to statements about veterans' health care.

President Trump has made 901 false or misleading claims related to health care since taking office three years ago, a Washington Post database shows.

His foremost claim? That his administration single-handedly overhauled care for veterans with the 2018 Mission Act — a measure that does make it easier for some vets to visit private medical providers but is mostly an update of a law signed by President Barack Obama.

His foremost claim? That his administration single-handedly overhauled care for veterans with the 2018 Mission Act — a measure that does make it easier for some vets to visit private medical providers but is mostly an update of a law signed by President Barack Obama.

Trump’s pronouncements on a range of health-care topics — such as preexisting condition protections, the effects of Medicare-for-all and the state of the Affordable Care Act — are among the more than 16,200 false or misleading claims he has made in his three years since taking the oath of office.

 The Post’s stellar fact-checking team, which in the administration’s first 100 days started a database for analyzing, categorizing and tracking every suspect statement Trump utters. At the request of readers, they kept it going.

Now the database shows Trump made 8,155 suspect claims in 2019, up from 5,689 claims in 2018 and 1,999 claims in the first year of his presidency.

“In a single year, the president said more than the total number of false or misleading claims he had made in the previous two years,” our colleagues Glenn Kessler, Salvador Rizzo, and Meg Kelly write. “Put another way: He averaged six such claims a day in 2017, nearly 16 a day in 2018 and more than 22 a day in 2019.”

President Trump has made 901 false or misleading claims related to health care since taking office three years ago, a Washington Post database shows.

His foremost claim? That his administration single-handedly overhauled care for veterans with the 2018 Mission Act — a measure that does make it easier for some vets to visit private medical providers but is mostly an update of a law signed by President Barack Obama.

Trump’s pronouncements on a range of health-care topics — such as preexisting condition protections, the effects of Medicare-for-all and the state of the Affordable Care Act — are among the more than 16,200 false or misleading claims he has made in his three years since taking the oath of office.

That’s the tally from The Post’s stellar fact-checking team, which in the administration’s first 100 days started a database for analyzing, categorizing and tracking every suspect statement Trump utters. At the request of readers, they kept it going.

Now the database shows Trump made 8,155 suspect claims in 2019, up from 5,689 claims in 2018 and 1,999 claims in the first year of his presidency.

“In a single year, the president said more than the total number of false or misleading claims he had made in the previous two years,” our colleagues Glenn Kessler, Salvador Rizzo, and Meg Kelly write. “Put another way: He averaged six such claims a day in 2017, nearly 16 a day in 2018 and more than 22 a day in 2019.”

Here are Trump’s top five misleading health-care claims, in order of how frequently he has repeated them:

1. Trump is particularly fond of making bold claims about how the Veterans Affairs Mission Act came about and what it did.  Although the Act was passed into law many of its regulations were never implemented.  He has claimed the legislation was all his idea. He has suggested Congress couldn’t get the measure approved for 44, 45 or even 48 years. He has made these claims — or iterations of them —113 times, according to the Post database. The actual history of the VA Choice program goes like this: Congress passed the program under Obama as a way of addressing the 2014 scandal in which Veterans Affairs facilities were found to be obscuring long wait times for medical appointments. The program allowed one-third of veterans to get government-paid health care in private settings.

2. Trump has made all sorts of dubious claims about the 2010 Affordable Care Act, calling it “crazy,” “a disaster” and “not working.” He has made such claims 80 times.

3. The president has another favorite overstatement related to veterans’ health care: that a June 2017 measure he signed allowed underperforming VA workers to be fired for the first time ever.

4. Trump’s claims around patients with preexisting health conditions (including one that Glenn gave “Four Pinocchios”) have attracted the most ire from Democrats.

5. This attack — that Democrats want to eviscerate the Medicare program — was popular among Republicans in the 2018 election as they tried to turn the health-care issue to their advantage. Trump has repeated such claims 56 times.

The details of these lies are in the link below




The Health 202: Here are President Trump's top five health-care whoppers - The Washington Post: The top one goes to statements about veterans' health care.

The Personal Care Act

Past approaches to fixing our healthcare system have led to an absurdly complicated and convoluted system based on political motivations - see examples such as the “Affordable Care Act,” which crippled the ability for Americans to gain access to healthcare in the name of health coverage. 

The truth is the status quo is broken. Prices and spending levels continue to rise. The healthcare bureaucracy continues to grow. Americans are hurting because of it.

In order to fix our system, we need healthcare freedom.  

The Personalized Care Act will put millions of Americans in control of their healthcare choices by expanding Health Savings Accounts (HSAs) - a mechanism necessary to creating healthcare freedom which will allow Americans to personalize their care. Under this bill, funds from HSAs can be used for options such as direct medical care, healthcare sharing ministries, medications, and insurance premiums.

No one should stand in the way of you and your doctor – this includes government and insurance bureaucrats. H.R. 5596, the Personalized Care Act, works to eliminate the growing healthcare bureaucracy by allowing individuals to control their healthcare dollars - tax-free. Healthcare is personal, and Americans deserve a personalized approach.

HEALTH CARE SHARING MINISTRIES.

The following organizations support H.R. 5596:

Heritage Action

Association of American Physicians and Surgeons

National Taxpayers Union

Americans for Prosperity

DPC Action

Cardiac Rehabilitation Attendance Low Among Medicare Beneficiaries | MD Magazine

An analysis of Medicare data has uncovered a startling trend regarding rehabilitation for patients who suffered a cardiovascular event or surgery. 

Cardiac Rehabilitation Attendance Low Among Medicare Beneficiaries

JANUARY 14, 2020

Patrick Campbell

@RealPatCampbell

Matthew Ritchey, DPT, MAn analysis of Medicare data has uncovered a startling trend regarding rehabilitation for patients who suffered a cardiovascular event or surgery.Results of the analysis, which was led by Matthew Ritchey, DPT, MPH, of the Centers for Disease Control Prevention (CDC), indicated less than 1 in 4 eligible patients participated in a cardiac rehabilitation program and just 24% of those who did participate started the program within 21 days of the event or surgery"The low participation and completion rates observed translate to upwards of 7 million missed opportunities in this study to potentially improve health outcomes if 70% of them covered by Medicare who had a heart attack or acute heart event or surgery participated in cardiac rehabilitation and completed 36 sessions,” said Ritchey, a researcher at the CDC’s Division for Heart Disease and Stroke Prevention, in a press release.

In spite of mountains of data indicating the beneficial impact of cardiac rehabilitation on outcomes following cardiovascular events or procedures, improving patient participation and adherence remains a challenge. To assess the progress of programs like the Million Hearts Cardiac Rehabilitation Collaborative, investigators conducted an observational analysis of Medicare Part A and Part B claims data from fee-for-service beneficiaries 65 years and older between 2016 and 2017.

The shocking news is that this is a fully covered Medicare Benefit.  

Inclusion criteria included experiencing 1 or more AMI hospitalization, CABG, heart valve repair or replacement, percutaneous coronary intervention, or heart or lung transplant. Patients also needed to be alive for more than 21 days following their qualifying event, have continuous Medicare Part A and Part B enrollment for 12 or more months following the event if they survived to that point, and not be entitled to Medicare benefits due to having an end-stage renal disease.

Using these criteria, investigators identified a cohort of 366,103 patients who were eligible for cardiac rehabilitation, of which 89,327 (24.4%) participated in such a program. Further analysis revealed only 24.3% of those who participated began within 21 days of the event or procedure and just 26.9% of participants completed cardiac rehabilitation.

Results also indicated participation varied based on the ethnicity of the beneficiary. Participation rates were highest among Non-Hispanic whites, with non-Hispanic blacks being 0.7 times (adjusted prevalence rate [aPR] 0.70; 95% CI, 0.67–0.72) as likely and Hispanics 0.63 times (aPR 0.63; 95% CI, 0.61–0.66) as likely to participate than their white counterparts.

Age also appeared to impact participation rates among beneficiaries. Among those 85 years and older, only 9.8% (aPR 0.57; 95% CI, 0.56–0.59) of eligible beneficiaries participated in a rehab program—compared to 24.8% (aPR 0.93; 95% CI, 0.92–0.95) among those 75 to 84, and 31.7% among those 65 to 74 years old.

Ritchey and colleagues noted multiple limitations to consider when interpreting the results of their analysis. Limitations included being unable to assess referral rates with the use of billing data, clinical information was not available for all patients, investigators were unable to control for factors such as availability of programs, and because only cardiac rehabilitation was assessed results may not be generalizable to Medicare Advantage members or younger patients.

Based on the results of their analyses, Ritchey suggests more work is needed to promote and encourage participation in cardiac rehabilitation programs if clinicians seek to maintain the improvements in cardiovascular outcomes seen in recent years.

Despite cardiac rehabilitation (CR) being shown to improve health outcomes among patients with heart disease, its use has been suboptimal. In response, the Million Hearts Cardiac Rehabilitation Collaborative developed a road map to improve CR use, including increasing participation rates to ≥70% by 2022. This observational study provides current estimates to measure progress and identifies the populations and regions most at risk for CR service underutilization.

Despite the importance of CR use to improve health outcomes after a qualifying cardiac event, participation and completion remain low among eligible Medicare FFS beneficiaries. Furthermore, disparities and considerable geographic variability persist. A wealth of guidance exists that identifies the evidence-based strategies that can be used to increase CR use. Hospitals, CR programs, and other stakeholders can consider systematically integrating these strategies into their processes and tracking the effects of their implementation using established quality and performance measures. Continued innovation in the delivery of services may help meet the needs of the groups most underserved, as well as to increase the capacity to provide care for all those who qualify. The findings in this article and future analyses can be used to assess the impact these collective efforts have on achieving national CR utilization goals.

There is a serious disconnect between cardiologists, cardiothoracic surgeons, and their patients. Preoperative counseling should include the necessity of post-operative rehabilitation In the cases of open heart surgery chest wall physiology is radically altered due to the opening of the thoracic cavity.  For patients in heart failure prior to diagnosis and treatment, it is likely that patients have become de-conditioned due to dyspnea and fatigue.  Once treated their body literally has to catch up with a healthier heart/

Cardiac Rehabilitation Attendance Low Among Medicare Beneficiaries | MD Magazine: