The Healthcare Policy Podcast ® Produced by David Introcaso

Listen Now Nurses, today numbering over four million, represent the largest segment of the healthcare workforce and deliver the majority of direct patient care.   Their role in determining care quality (and safety) cannot be under-estimated.  Absent adequate nursing care patients can face a long list of nonfatal and fatal outcomes.  The profession however suffers a number of challenges due in part...

Listen Now Healthcare payment models have been increasingly evolving to include quality performance in determining reimbursement.  For example, the Medicare program, including Medicare Advantage, is today littered with quality performance measurement.  Measuring quality in healthcare is, however, not as simple or straight forward as frequently assumed.   Among other challenges, measures developed...

Listen Now The Medicare Shared Savings Program's Accountable Care Organization (ACOs), created by Section 3022 of the 2010 Affordable Care Act constitutes the flagship Medicare pay for performance (P4P) program.  Though there are other P4P (also termed pay for value) models, for example two bundled payment models (Bundled Payments for Care Improvement and Comprehensive Care for Joint Replacement),...

Listen Now Including the February 14th shooting at Marjory Stoneman HS in Parkland Florida that killed seventeen students and teachers, there have now been over 130 shootings in elementary, middle and high schools in 43 states since 2000 and another 58 shootings in US colleges and universities.  Gun violence in this country is in a word, obscene.  It is, for example, 96 times higher than in Japan...

Listen Now In January the Trump administration published a proposed DHHS rule titled, "Protecting Statutory Conscience Rights in Health Care, Delegations of Authority."  For decades the federal government, via several legislative amendments, has protected healthcare providers who object to performing, or object to assist in performing, certain medical procedures based on their freedom of conscienc...

Listen Now During this 29-minute interview, Professor Timothy Hoff discusses moreover what market factors explain or are driving the degradation of the therapeutic relationship between the physician and the patient, or what he terms the doctor-patient dyad, these include the "retailing" of medicine, whether "next in line" retail medicine, where we've traded relational trust for calculative trust,...

Listen Now During this 30-minute interview Professor Engel discusses moreover why, as he notes, US healthcare is "uniquely dysfunctional," and "laden with profit taking" largely due to induced demand, provides an overview of efforts to contain spending growth via HMOs both in the commercial and the Medicare market, the success of Medicaid HMOs, and discusses his disappointments with the Affordable...

Listen Now This past January 9th CMS announced Bundled Payment for Care Improvement (BPCI) Advanced.  This five-year Medicare bundled or episode-based payment demonstration, that begins this October 1st, will succeed the agency'a five-year BPCI demonstration that sunsets this September 30th.  BPCI Advanced, also voluntary, will be considerably less expansive than its predecessor in that, among oth...

Listen Now In a letter last March to state Medicaid directors by then DHHS Secretary Tom Price and CMS Administrator Seema Verma telegraph the administration's intent to radically redefine the Medicaid program.  Believing the ACA's expansion of the Medicaid program was, per the March letter, a "clear departure from the core, historical mission of the program,"  administration officials telegraphed...

Listen Now In early February the Human Rights Watch (HRW) published, "'They Want Docile': How Nursing Homes in the US Over-medicate People with Dementia."  The inappropriate or misuse of antipsychotics, e.g., Haldol, Seroquel and Risperdal, in nursing facilities to chemically restrain nursing home patients, moreover frail and elderly seniors, has been practiced for decades.  The HRW report found i...

Listen Now Fatalities related opioid use now account for over two-thirds of all drug overdoses annually, over 60,000, in the US.  Approximately 115 Americans die every day from an opioid overdose.  This number represents a five-time increase over the past two decades.  Opioid-related fatalities have become so prevalent, according to the National Center for Health Statistics, they have caused a dec...

Listen Now A year ago last week the President Trump signed an executive order reinstituting the so called global gag rule (more formally termed the Mexico City policy).  The policy was first implemented by President Reagan and has gone in and out of effect depending on whether a Republican or Democrat holds the White House.  The initial policy only applied to abortions, i.e., in order to obtain US...

Listen Now This past November 16 CMS published the agency's final 2018 MACRA (Medicare Access and CHIP Reauthorization Act) rule (at 661 federal register pages).  MACRA, authorized in 2015, formulates how approximately 1.5 million Medicare Part B physicians and other eligible clinicians are reimbursed.  Annual MACRA proposed and final rule making is closely monitored since the law's MIPS (Merit-Ba...

Listen Now CMS has been experimenting with Medicare bundled payment arrangements, where the provider is reimbursed a total fee (either prospectively or reconciled retrospectively), for three decades.  Under ACA authority CMS' Center for Medicare and Medicaid Innovation (CMMI) has launched several five-year bundled payment demonstrations, most notably BPCI that began in 2013.  The BPCI demo allows...

Listen Now Despite the fact an estimated 100 million Americans suffer from chronic pain costing approximately $640 billion annually in medical expenses and lost productivity, the disease remains widely under treated.  This is all the more true for ethnic and racial minorities independent of age, gender, education, wealth and pain intensity.  Despite recent efforts by the Institute of Medicine, the...

Listen Now This, my 125th interview, will discuss Oregon's Coordinated Care Organizations (CCOs) that have received considerable attention nation-wide for their ability to provide Medicaid beneficiaries with coordinated care, moreover primary care services integrated with mental/behavioral and oral health.  The Oregon CCO model has also demonstrated over the past five years an ability to improve c...

Listen Now Over the past 20 years Dr. Ronald Epstein has published on the topic he terms "mindful practice."  "Mindful practice," he argues, enables physicians and other clinicians to have heightened self-awareness that allows in turn for greater attentiveness or greater presentness in caring for patients.  It is what makes good providers, he says, great.   During this 26-minute conversation Dr. E...

Listen Now Electronic Health Records (EHRs) were largely adopted after 2009, or after the Congress passed the HITECH Act that appropriated $30 billion in financial incentives for hospital and physicians to migrate from paper to digital records.   In theory the policy made/makes perfect sense.  Adopting information technology/IT would over time create efficiencies, drive better care coordination an...

Listen Now Mr. Eric Weinberg is co-author with College of New Jersey Journalism Professor, Donna Shaw, of the recently published work,  Blood On Their Hands, How Greedy Companies, Inept Bureaucracy, and Bad Science Killed Thousands of Hemophiliacs (Rutgers University Press).  The book details how beginning in the late 1970s through the mid-1980s tens of thousands of hemophiliacs in the US (and ten...

Listen Now Earlier this year St. Martin's Press published Dr. Haider Warraich's Modern Death, How Medicine Changed the End of Life. As the dust jacket notes, "the mechanics and understanding" of dying, "the whys, wheres, whens and hows are almost nothing like what they were mere decades ago."  Today, eight in ten Americans die at an advanced age, or under Medicare, die in a medical setting after s...

Listen Now Recently the National Academy of Medicine (NAM) (formerly the Institute of Medicine) released it's "Effective Care for High-Need Patients, Opportunities for Improving Outcomes, Value and Health."  The report attempts to address a long-standing problem in health care delivery, e.g., five percent of patients ("high-need" patients) account for, or consume, 50 percent of health care resourc...

Listen Now Approximately three weeks ago New York Magazine published David Wallace-Well's 7,500 word essay "The Uninhabitable Earth, Famine, Economic Collapse, A Sun That Cooks Us: What Climate Change Could Wreak - Sooner Than You Think."  The article has to date been downloaded over 4.5 million times.  It is the most read essay the magazine has ever published.  The essay begins with, "If your anx...

Listen Now During this 20 minute discussion Dr. Halee Fischer-Wright discusses her recently published work, "Back to Balance, The Art, Science and Business of Medicine."  As the title suggests, Dr. Wright argues the practice of medicine has become dominated by the business and science aspects of care delivery both to the detriment of both the patient and the physician.   Dr. Halee Fischer-Wright i...

Listen Now  A 2012 National Academy of Sciences (Institute of Medicine) study titled, "Best Care and Lower Cost," found about one quarter of all medical spending is wasted, much of this excessive spending going to pay for treatments that are of unknown effectiveness.   With medical spending now accounting  for one-sixth of the nation's GDP, or over $3 trillion annually, how do we limit spending to...

Listen Now Approximately 8,700 Americans die annually awaiting a kidney donation or become too ill to receive one.  This is half the number of those who annually receive a kidney, or 17,000.   Over 100,000 at any time are awaiting a kidney.  The median wait time is over three and a half years.  One-third of kidney donations are live donations typically from a child, parent, sibling, spouse or othe...