The Healthcare Policy Podcast ® Produced by David Introcaso

Listen NowConcierge medicine (also termed membership medicine, direct pay or cash only practice) has become a rapidly-growing care model moreover among primary care physicians.  In concept, physicians charge patients a monthly or annual fee that can vary widely from approximately $50 per month to $25,000 per year (or accept cash only per visit).  In exchange patients are promised greater access, longer appointment times and possibly services not typically reimbursed by payers.  The current number of physicians practicing concierge medicine is today small, approximately 5,500 nationwide, however, concierge practices are expected to continue to grow at a healthy rate, currently estimated at 25% per year.  While these fees enable physicians to reduce patient panel size and presumably improve physician satisfaction, the model by definition posses access problems for the sickest patients, typically those least able to afford a concierge fee.  For example, among Medicare beneficiaries, in 2012 half of all had annual incomes less than $22,500 and for African American and Hispanic Medicare beneficiaries annual income was less than $15,000. During this 21 minute discussion Ms. Schwarz explains the intersection between concierge medicine and the Medicare program, related investigative efforts by CMS and the DHHS Office of the Inspector General, whether there is any data showing improved care quality and/or reduced health care system costs, whether the practice of concierge medicine constitutes patient abandonment and what would the Medicare Rights Center tell a beneficiary if they called the Center inquiring about the appropriateness and merits of concierge medicine.    Ms. Casey Schwarz is currently the Policy and Client Services Counsel at the Medicare Rights Center in Washington, DC.  Among other duties Ms. Schwarz represents individuals in appeals and directly counsels individuals with complicated Medicare questions.  She works closely with the Medicare statute, regulations, and guidance on a daily basis, including drafting responses to proposed regulatory changes.  She also provides trainings for legal and other professionals working with Medicare clients.  Prior to her Rights Center work Ms. Schwarz served as a Court Attorney in the New York County Supreme Court.  Ms. Schwarz is a graduate of Brown University and the New York University School of Law.  She is a member of the New York  and Maine State Bars. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowThe term "medical home" was first introduced in the 1960s by the pediatric profession.  Still to date this model of care emphasizes team-based comprehensive, continuous and coordinated care.   The care model is intended to improve primary care generally via improved patient communication, care quality, safety and outcomes.  In several ways the ACA encouraged the adoption of the, now termed, Primary Care Medical Home/PCMH for both the Medicaid and Medicare programs and among private health insurers.   (In some ways the PCMH is seen as a precursor for providers interested in becoming an Affordable Care Organization (ACO), i.e., taking on reimbursement risk.)  Over the past few years PCMHs have become widely adopted.  Over forty state Medicaid programs are experimenting with the model along with 90 commercial health plans and three federal initiatives. During this 23 minute discussion Dr. Nielsen discusses the PCPCC's purpose and goals, more specifically what is the PCMH model of care, the varying ways PCMH's are reimbursed, what does the research to date show regarding PCMH effectiveness and challenges in adopting this new model of care.Dr. Marci Nielsen currently serves as CEO of the Patient Centered Primary Care Collaborative (PCPCC), an organization dedicated to advancing an effective and efficient health system built on a foundation of primary care.  Prior to the PCPCC, Dr. Nielsen served as Vice Chancellor for Public Affairs and Associate Professor at the University of Kansas School of Medicine’s Department of Health Policy and Management.  Dr. Nielsen was appointed by then-Governor Kathleen Sebelius as first Executive Director and Board Chair of the Kansas Health Policy Authority (KHPA).  She worked as a Legislative Assistant to Senator Bob Kerrey and later served as the health lobbyist for the AFL-CIO.  Dr. Nielsen is a board member of the American Board of Family Medicine and also a committee member for the Institute of Medicine’s Leading Health Indicators for Healthy People 2020 and Living Well with Chronic Illness: A Call for Public Health Action.  Early in her career she served as a Peace Corps volunteer in Thailand and served for six years in the US Army Reserves.  Dr. Nielsen earned her MPH at The George Washington University and her Ph.D. from the Johns Hopkins School of Public Health.The PCPCC's 1/14 PCMH impact on cost and quality report can be found at: http://www.pcpcc.org/newsletter/annual-report-pcmhs-impact-cost-quality-2012-2013. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowIn late January in a case involving a Catholic charity, the US Supreme Court issuesd a ruling temporarily exempting religious-affiliated non-profits from providing ACA-required contraceptive coverage.  (The ACA coverage requirement was based on an IOM recommendation that found birth control is "medically necessary."  The requirement took effect January 1st).  While churches and houses of worship are exempt, owned or controlled religious organizations can opt out of the contraceptive coverage requirement by completing and signing a form explaining their objection.  However, opponents say by opting out - that then allows the employee to obtain contraceptive coverage through a separate insurance policy - they are complicit in immoral conduct, i.e., they too should be exempted outright.  In addition, the Supreme Court has agreed to hear two cases that involve for-profit companies similarly objecting to the requirement.  During this 20 minute conversation Mr. Sonfield discusses the specifics of the ACA contraception coverage requirement and why it was included as an "essential health benefit, exemptions to it including how religiously affiliated non-profits can avoid providing coverage and moreover, in light of the recent legal challenges to the contraception mandate, what the research shows regarding the benefits of women's contraception.              Adam Sonfield joined the Guttmacher Institute in Washington DC in 1997.  (Guttmacher is a non-partisan reproductive health and rights research and policy shop.  Its goal is to "ensure the highest standard of sexual and reproductive health for all people worldwide.")  Adam currently serves as a Senior Public Policy Associate.  He is the managing editor and a regular contributor to the Institute’s public policy journal, the Guttmacher Policy Review.  Mr. Sonfield’s portfolio includes research and policy analysis on public and private financing of reproductive health care in the United States, the rights and responsibilities of health care providers and patients, and men’s sexual and reproductive health. He also writes a quarterly Washington Watch column for Contraceptive Technology Update.  Mr. Sonfield earned an A.B. with honors in social studies from Harvard and a Master of Public Policy, focusing in health policy, at Georgetown University.The Guttmacher Institute's Supreme Court amicus brief can be found at: http://www.guttmacher.org/media/inthenews/2014/01/31/index.html, This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen Now(This podcast is a companion to the November 13th interview with Infectious Diseases Society of America's Amanda Jezek.)  As previously noted, conservative estimates show hospital-acquired infections (HAIs) alone sicken two million Americans, directly kill 23,000 and contribute to a total of 100,000 deaths each year.  The bacterial infection C. diff (Clostridium difficile) alone causes 250,000 people to be hospitalized annually.  The US has some one of the highest infection resistant rates among developed countries and within the US infection rates are highly variable.     During this 25 minute conversation Dr. Anthony Harris discusses why comparatively US infection resistance rates are high, why hand hygiene compliance rates remain persistently high (despite the fact hand contamination contributes substantially the the spread of infections), what acute care providers can do to reduce infections, what activites SHEA is pursuing to help reduce infection rates and what more can be done nationally, specifically regarding quality metrics, to lower rates. Dr. Anthony Harris is currently a Professor of Epidemiology and Public Health at the University of Maryland's School of Medicine and is the President-Elect of SHEA.  His research interests include emerging pathogens, antimicrobial-resistant bacteria, hospital epidemiology/infection control, epidemiologic methods in infectious diseases and medical informatics.  He has published over 100 research papers and currently receives funding from the NIH, CDC and AHRQ to study antibiotic resistant infections and hospital epidemiology.  Dr. Harris received his medical degree from McGill Univesity and his MPH from Harvard. For information on SHEA's compendium of strategies to prevent health care associated infections see:  http://www.shea-online.org/HAITopics/CompendiumofStrategiestoPreventHAIs.aspxFor information on SHEA's research network of 200 hospitals see:  http://www.shea-online.org/Research/SHEAResearchNetwork/SRNStudiesandResources.aspx This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen Now The Emergency Medical Treatment and Labor Act (EMTALA) was passed in 1986 under the Reagan administration to help prevent patient dumping.  The law requires hospitals to provide emergency medical treatment to anyone regardless of citizenship, legal status or ability to pay.  In recent years however hospitals have begun to impose upfront emergency room fees.  Today approximately half of all hospitals do so.  Hospital executives claim these fees reduce ER overcrowding by diverting patients with non-emergency needs.  Patient advocates claim the fees undermine EMTALA's intent and causes patients' health conditions to worsen.  For example, in 2011 one large national hospital chain saw 80,000 patients leave their emergency rooms untreated when faced with a $150 use fee.  During this 17 minute podcast Professor Rosenbaum explains what generally EMTALA requires, when ER fees can be legally solicted or collected, the negative effects of fee collection, she questions the legitimacy of the industry's argument that fees help to encourage more appropriate site of care use and what can be done to provide better oversight and enforcement of EMTALA.     Professor Sara Rosenbaum is the Harold and Jane Hirsh Professor of Health Law and Policy and Founding Chair of the Department of Health Policy at The George Washington University School of Public Health and Health Services.  Professor Rosenbaum is best known for her work on the expansion of Medicaid and community health centers, patients' rights in managed care, civil rights and health care, and national health reform.  She is the lead author of Law and the American Health Care System, a landmark textbook that provides an in-depth exploration of the interaction of American law and the U.S. health care system.  She has received numerous national awards for her work, serves on governmental advisory committees, private organizational and foundation boards, and is a past Chair of AcademyHealth. She is a member of the CDC Director's Advisory Committee, the CDC Advisory Committee on Immunization Practice and a Commissioner on the Medicaid and CHIP Payment and Access Commission (MACPAC).  She received her BA from Wesleyan and her JD from Boston University. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowOf the two and a half million Americans that die annually, less than half, or 45%, die under hospice care. About one-third of these deaths are cancer related the remainder are moreover from heart and lung disease and dementia.  Of the over 5,000 hospice providers nearly two-thirds are for profit.  Over 80% of all hospice care is paid for by Medicare.  While hospice care is ever-increasingly becoming accepted by the public, the program's benefits are compromised largely due to the fact that over one-third of hospice enrolled decedents were enrolled in the program for too short a period of time, or less than seven days.  During this 21 minute podcast, Dr. Doblin discusses why he became a hospice physician, what makes for good hospice care, why the benefit remains under-utilized, what constitutes a "good death," how might hospice and palliative care be improved and how these services might better fit  in ever-evolving changes in the health care industry.     Dr. Bruce H. Doblin is currently a Physician in the Department of Internal Medicine at Northwestern Memorial Hospital.  He also serves as an Instructor of Clinical Medicine-Internal Medicine at the Northwestern University Feinberg School of Medicine.  Previously, Dr. Doblin served for over ten years as the Medical Director for Seasons Hospice and Palliative Care in Chicago.  Dr. Doblin earned his BA in Economics at Williams College and his MD and Masters in Public Health from Northwestern University.  He completed fellowship training at UCLA in health services research and at the University of Chicago in Clinical Medical Ethics. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen Now Transcendental Meditation (TM) has long been studied as an approach to improving health status generally and lowering blood pressure specifically.  For example, the American Heart Association published research in 2012 that found African Americans who practiced TM regularly over five years were almost half as likely to have a heart attack or stroke or die from all causes compared to African Americans who attended health education classes due to lowered blood pressure and improved anger management.  Among other applications, TM has also shown to be effective in reducing PTSD and polytrauma among active military service members and veterans.  During this 21 minute podcast Dr. Schneider discusses what's meant by the "mind-body-heart" connection, what role can/does TM play in influencing these connections, the research evidence for TM's use in reducing hypertension and more generally stress and anxiety for a wide variety primary and secondary disease prevention purposes and the level of acceptance for TM within the medical community.     Dr. Robert Schneider is currently the Director and Senior Investigator of the Center for Natural Medicine and Prevention at the Maharishi University of Management Research Institute.  Over the course of his career Dr. Schneider has been awarded more than $20 million in grants from the NIH for his pioneering research on natural approaches to reducing heart disease.  Dr. Schneider is a Fellow of the American College of Cardiology, a former member of the White House Commission on Complementary and Alternative Medicine Policy and has has served on numerous commissions and expert panels for the Congress, the CDC and others.  Dr. Schneider is the author of Total Heart Health and over 100 medical research articles.  He has been featured in numerous media reports including CNN, The New York Times, and Time magazine.  He received his MD from the University of Medicine and Dentistry of New Jersey and did his residency training at the University of Michigan Medical Center. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowHuman physiology or biological functioning exhibits fractal or irregular patterns.  When heart rate, (or respiration rate, blood pressure, brain waves and even walking stride length) begins to lose its fractal dimension or there is a loss of heartbeat variability, this is an indication of illness.  In order to respond best to environmental circumstances, adaptative variability (not homeostasis) is what organisms strive toward.  Measuring therefore the decline in heart rate variability over time can serve as a clinically effective biomarker for the onset of disease, for example, the onset of chronic obstructive pulmonary disease (COPD), one of the leading causes of hospitalizations and re-hospitalizations.  During this 20 minute interview Professor Palmer explains briefly the science behind what explains heart rate variability and variability more generally in biological functioning, what are the clinical or health care or clinical applications for this research, his research to avoid COPD hospitalizations and the onset of infection for leukemia patients, the larger implications of this research work and receptivity toward this different paradigm in understanding biological functioning and disease progression.Dr. James Palmer is an Assistant Professor in Family Medicine at the University of Colorado's Anshuyltz Medical Campus in Denver.  His research concerns testing and developing the use of heart rate interval dynamics as an actionable prognostic biomarker for earlier detection and diagnosis COPD exacerbation.  Dr. Palmer also has an independent professional practice that designs applications of complexity sciences to improve clinical care processes and outcomes.  His work has helped to develop and implement healthcare improvement projects both in the US and Canada.  Dr. Palmer completed his Doctor of Management in 2007 at the Complexity and Management Centre, University of Hertfordshire, UK.  He was also educated as an economist at the University of Chicago (MA) and Texas Christian University (BA).For a review of the theory behind and applications for monitoring variability see, for example, Andrew JE Seely, et al. "Continuous Multiorgan Variability Monitoring in Critically Ill Patients - Complexity at the Bedside," at: http://www.therapeuticmonitoring.com/files/IEEE-CIMVA-paper_Boston_Sep-2011.pdf  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowAccording to Information Week there are now approximately 100,000 mobile medical applications (double the number from last year) and the market for these applications is expected to grow from $500 million in 2010 to $8 billion by 2018.  These applications promise to provide the consumer with everything from health and wellness information to cancer diagnoses.  What do we know about who uses mobile medical applications or digital therapeutics, why and to what effect?    During this 22 minute interview Ms. Marchibroda describes four general categories of mobile medical applications, their parochial uses by the public, healthcare providers, employers and insurers, what's known about their effectiveness, potential downsides and why the FDA is regulating these (and future federal regulation of health information technology more generally).  Ms. Janet Marchibroda is currently the Director of the Health Innovation Initiative and the Executive Director of the CEO Council on Health and Innovation at the Bipartisan Policy Center in Washington, DC.  Ms. Marchibroda also serves as a board member for Doctors Helping Doctors Transform Health Care.  Ms. Marchibroda previously led stakeholder engagement activities for the National Coordinator for Health Information Technology at DHHS, served as the Chief Health Care Officer at IBM, served as the founding Chief Executive Officer for eHealth Initiative (eHI) and also served as the Chief Operating Officer of the National Committee for Quality Assurance.  Among other awards she's been recognized as one of the Top 25 Women in healthcare by Modern Healthcare magazine.  Ms Marchibroda was graduated from the University of Virginia with a BS and from The George Washington University with an MBA. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowIn 1999 the Institute of Medicine published "To Err Is Human," a report that shocked the medical establishment because it concluded as many as 98,000 Americans die annually from hospital caused medical errors.  In 2000 the highly respected scholar Dr. Barbara Starfield estimated medical errors or adverse events actually amount to 225,000 deaths annually making them the 3rd leading cause of death after heart disease and cancer.   Most recently a study published this past September in the Journal of Patient Safety estimated medical errors cause between 210,000 to 440,000 deaths annually.  Added to these sobering estimates is the fact there's never been an actual count of how many patients have been killed by medical errors and what progress that has been made in reducing errors, or at least the growth in the number of errors, has been charterized as "frustratingly slow" and "agonizingly slow."During this 23 minute intereview Ms. Gibson discusses the prevalence of medical errors and why she believes the rate of medical harm is actually getting worse.  She explains why she believes both the medical community's response as well as federal and state government responses have been inadequate and what is needed to reverse this extraordinary number of medical-related deaths.       Ms. Rosemary Gibson is a Senior Advisor at the non-profit Hasting Center, a research organization dedicated to addressing ethical issues in health, medicine and the environment.  Ms. Gibson is also an editor for JAMA Internal Medicine.  Previously, Ms. Gibson was a Program Officer at the Robert Wood Johnson Foundation where she addressed safety and quality issues particularly in palliative care.  Among other books Ms. Gibson is the author of "Wall of Silence, The Untold Story of the Medical Mistakes That Kill and Injure Millions of Americans."  Ms. Gibson serves on numerous boards including the Consumers Union Safe Project and among others she received the Lifetime Achievement Award from the American Academy of Hospice and Palliative Medicine.  Ms. Gibson is a graduate of Georgetown University and the London School of Economics.To learn more about Ms. Gibson's work go to: http://www.amazon.com/s/?ie=UTF8&keywords=rosemary+gibson&tag=googhydr-20&index=stripbooks&hvadid=18834377909&hvpos=1t1&hvexid=&hvnetw=g&hvrand=187281419643604594&hvpone=&hvptwo=&hvqmt=b&hvdev=c&ref=pd_sl_6ynacw5hh2_b This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com