DYING, ILLNESS, AND AGING WITH GRACE

 Here's a link to a 2023 list of recommended changes in health care:
NEWS: Sanders and Marshall Announce Bipartisan Legislation on Primary Care (US Senate Committee on Health, Education, Labor & Pensions, 9-14-23)

https://www.help.senate.gov/chair/newsroom/press/news-sanders-and-marshall-announce-bipartisan-legislation-on-primary-care

"According to the most recent estimates, over the next decade the United States faces a shortage of over 120,000 doctors — including a huge shortage of primary care doctors -- and the nursing shortage may be even worse. Over the next two years alone, it is estimated that we will need between 200,000 and 450,000 more nurses.

    "The Sanders-Marshall agreement answers this crisis by providing over $26 billion in funding to expand primary care in America and address the health care workforce shortage:

 

Provides $5.8 billion a year over the next three years in mandatory funding for community health centers which provide high-quality primary health care to more than 30 million Americans.

Within those funds there is a $245 million per year set aside to expand hours of operation at community health centers and $55 million per year for school-based health services.

Health centers will be newly required to provide nutrition services.

Provides $3 billion in capital funding primarily to enable community health centers to expand dental care and mental health care in their facilities.

Increases funding for the National Health Service Corps from $310 million to $950 million per year over the next three years to provide 2,100 scholarships and debt forgiveness for some 20,000 doctors, nurses, dentists, mental health providers, and other health care professionals who commit to working in our nation's most underserved areas.

Provides $1.5 billion over the next five years in the Teaching Health Center Graduate Medical Education program to create more than 700 new primary care residency slots, which would result in up to 2,800 additional doctors by 2031. This program increases the number of primary care physicians and dental residents trained in community-based settings. In Academic Year 2021-2022, the program funded more than 930 individual primary care medical and dental residents, who provided more than 1.1 million hours of patient care to more than 800,000 patients in medically underserved and rural areas.

Addresses the nursing shortage in America by investing $1.2 billion in grants to community colleges and state universities to increase the number of students enrolled in accredited, two-year registered nursing programs. The schools receiving these awards must use them to expand their class sizes and grow the number of two-year nurses trained across the country. This provision would allow schools to train up to 60,000 additional two-year nurses.

Provides $300 million to produce an additional 2,000 primary care doctors by 2032. The bill will also increase residency programs in rural America through an investment in the Rural Residency Planning and Development program and invests in training and workforce programs for dentists and dental assistants.

 

The legislation will be fully paid for by combatting the enormous waste, fraud and abuse in the health care system, making it easier for patients to access low-cost generic drugs and holding pharmacy benefit managers accountable, among other provisions.

 

 

Sandors Payfors

(Bipartisan Primary Care and Health Workforce Act Bipartisan Offsets)

Possibly for 2011, but clearly about funding, and the ideas listed make sense:

My guess anyone searching for articles and research on these topics would find research gold. Clearly pharmacy benefit managers were a big part of the health care funding problem in 2011 (rather than a solution).

 

Require honest billing by hospitals

Prohibit facility fees for telehealth and evaluation and management services

Prohibit anticompetitive contract clauses in commercial insurance

Pharmacy Benefit Managers/Generic Drug Package --- a suite of bipartisan bills addressing drug prices through reforms to pharmacy benefit managers (PBMs) and the generic drug market

Delinking PBM service fees

Prevention and Public Health Fund (reduce funding)

 

Other funding considerations: Up to $22.2 billion.

Medicaid improvement fund: Use these savings primarily to pay for increased funding for community health centers, the National Health Service Corps, and Teaching Health Centers Graduate Medical Education.

Expand program integrity for unemployment insurance

Extend the Sequester, but exclude Medicare (2011)

This series ran in 2022 but I am linking to stories that most of you won't have read, and should. 

• Patients for Profit: How Private Equity Hijacked Health Care (KFF Health News) Private equity investors are rapidly scooping up thousands of health care businesses, taking over emergency rooms or entire hospitals, and becoming major players in physician practices and patient care, from cradle to grave. But these acquisitions are often invisible to federal regulators. And their profit motives raise concerns about rising prices and the quality of treatment.

 

• Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties (Fred Schulte, KFF Health News, 11-14-22) Private equity firms have shelled out almost $1 trillion to acquire nearly 8000 health care businesses, in deals almost always hidden from federal regulators. The result: higher prices and complaints about care. Government should require 'added scrutiny' of private equity companies whose holdings run afoul of the law.

• Baby, That Bill Is High: Private Equity ‘Gambit’ Squeezes Excessive ER Charges From Routine Births (Rae Ellen Bichell, KFF Health News, 10-13-22) Routine births are turning into moneymaking ‘emergency’ events at hospitals that work with private equity-backed staffing companies. Federal regulators, meanwhile, are almost blind to the incursion, since private equity typically acquires practices and hospitals below the regulatory radar. KHN found that more than 90% of private equity takeovers or investments fall below the $101 million threshold that triggers an antitrust review by the Federal Trade Commission and the U.S. Justice Department. In the health care sphere, private equity has tended to find legal ways to bill more for medical services: trimming services that don’t turn a profit, cutting staff, or employing personnel with less training to perform skilled jobs — actions that may put patients at risk, critics say.

• Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties (Fred Schulte, KFF Health News, 11-14-22) As private equity extends its reach into health care, evidence is mounting that the penetration has led to higher prices and diminished quality of care, a KHN investigation has found. KHN found that companies owned or managed by private equity firms have agreed to pay fines of more than $500 million since 2014 to settle at least 34 lawsuits filed under the False Claims Act, a federal law that punishes false billing submissions to the federal government with fines. Most of the time, the private equity owners have avoided liability.

• Hospices Have Become Big Business for Private Equity Firms, Raising Concerns About End-of-Life Care (Markian Hawryluk, KFF Health News, 7-29-22) With the U.S. population rapidly aging, hospice has become a boom industry. And with limited oversight and generous payment, the industry is at high risk for exploitation. Agencies are paid a daily rate for each patient, which encourages for-profit hospices to limit spending to boost their bottom lines. For-profit hospices had Medicare profit margins of 19% in 2019, compared with 6% for nonprofit hospices. For-profit hospices tend to hire fewer employees than nonprofits and expect them to see more patients. If patients become too costly, requiring expensive care or medicines, hospice providers can discharge them, and take them to a hospital emergency room to get services the agencies don’t want to pay for themselves.

• Infections and falls increased in private equity-owned hospitals (National Institutes of Health, 1-23-24) Local hospitals might be owned by the university next door, by a non-profit organization, or by a for-profit company. Over the last decade, more and more hospitals have been purchased by private equity firms.The private equity model involves using investor money—and additional debt—to purchase an asset like a hospital. The firm typically then cuts operating costs, often sells the real estate portion, and attempts to re-sell the entity for a profit after several years. Hospitals saw a 25% increase in hospital-acquired conditions after acquisition by private equity firms relative to the control group. This increase was mainly driven by a spike in infections after the placement of a central line (a type of IV inserted near the heart to deliver drugs, fluids, or other substances) and an increase in falls. Private equity acquisitions led to higher charges, prices, and societal spending and a decline in the clinical quality of care delivered to hospital patients.

 

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk.

 

“The trauma caused by childhood neglect, sexual or domestic abuse and war wreaks havoc in our bodies, says Bessel van der Kolk in The Body Keeps the Score. . . . Van der Kolk draws on thirty years of experience to argue powerfully that trauma is one of the West’s most urgent public health issues. . . . Packed with science and human stories, the book is an intense read. . . . [T]he struggle and resilience of his patients is very moving.”
—Shaoni Bhattacharya, New Scientist

“War zones may be nearer than you think, as the 25 percent of US citizens raised with alcoholic relatives might attest. Psychiatrist Bessel van der Kolk argues, moreover, that severe trauma is ‘encoded in the viscera’ and demands tailored approaches that enable people to experience deep relief from rage and helplessness. In a narrative packed with decades of findings and case studies, he traces the evolution of treatments from the ‘chemical coshes’ of the 1970s to neurofeedback, mindfulness and other nuanced techniques.”
—Nature

“An astonishing amount of information on almost every aspect of trauma experience, research, interventions, and theories is brought together in this book, which . . . has a distinctly holistic feel to it. The title suggests that what will be explored is how the body retains the imprints of trauma. However, it delivers much more than this, delving into how the brain is impacted by overwhelming traumatic events, and is studded with sections on neuroscience which draw on the author’s own numerous studies as well as that of his peers. In addition, it investigates the effects of adverse childhood attachment patterns, child abuse, and chronic and long-term abuse. . . . [T]his book is a veritable goldmine of information.”
—European Journal of Psychotraumatology

“Dr. van der Kolk . . . has written a fascinating and empowering book about trauma and its effects. He uses modern neuroscience to demonstrate that trauma physically affects the brain and the body, causing anxiety, rage, and the inability to concentrate. Victims have problems remembering, trusting, and forming relationships. They have lost control. Although news reports and discussions tend to focus on war veterans, abused children, domestic violence victims, and victims of violent crime suffer as well. Using a combination of traditional therapy techniques and alternative treatments such as EMDR, yoga, neurofeedback, and theater, patients can regain control of their bodies and rewire their brains so that they can rebuild their lives. The author uses case histories to demonstrate the process. He includes a resource list, bibliography, and extensive notes. This accessible book offers hope and inspiration to those who suffer from trauma and those who care for them. It is an outstanding addition to all library collections.
—Medical Library Association, Consumer Connections