Whether they were finding funding for telecom systems, reaching out to build the program's network, or helping providers navigate new technology, one of the hurdles that Project ECHO Nevada faced before Zoom became a household name was how to connect health care providers in rural communities to the telementoring program.

Then, the COVID-19 pandemic accelerated the adoption of digital learning methods and created an environment that broke down virtual connection barriers amid social distancing measures and stay-at-home mandates.

We were always a virtual telehealth platform, Mordechai Lavi, M.D., medical director of Project ECHO Nevada, said. We connect and create virtual communities of learning where we amplify best practices and share knowledge. These types of communities can helpespecially in rural communities.

In Nevada, where more than two out of three people live in a primary care Health Professional Shortage Area (HPSA), according to the Physician Workforce in Nevada: A Chartbook, providing educational and support resources in rural areas is critical.

Through telementoring, rural clinicians can stay updated with the latest medical practices and treatments, which can directly translate into improved patient care and outcomes. This is especially vital for rural communities where accessing specialized medical training and resources may otherwise require extensive travel or be entirely out of reach.

As ECHO expands primary care physicians' knowledge base, patients benefit by reducing health care-related travel, long waits and costs. They receive quality care within their own communities when physicians can work together to solve medical problems.

In the years following the onset of the COVID-19 pandemic, Project ECHO continues to serve some of the most rural communities in the Silver State and demonstrate the value of its outreach. Rural health care and public health professional participation in the program grew by more than 26% from 2019 to 2022. During the same time, participation from all state organizations grew by 180%. And in 2023, the program experienced a 98% increase of case reviews conducted across all ECHO sessions from pre-COVID operations.

One of the cornerstone programs of Project ECHO is teleECHO programs, during which health care professionals across the state review patient cases with a multidisciplinary team of subject matter experts to collaborate on treatment using multi-point video technology. The case review process increases the impact of a session by providing the reviewing provider with recommendations about their case and offering other participants new skills and training.

A physician in Ely may have had a similar experience as a physician in Yerington and be able to share advice or recommend resources, Dr. Lavi said.

With interdisciplinary teams and shared experiences, ECHO sessions become a community of learning. Issues sometimes relate to navigating the vast health care system network, like prior authorization, income barriers or functional deficits, affecting whether a patient gets the care they need.

We can create that community of learning that Project ECHO is known for, Dr. Lavi said. It helps us connect so we can learn from each other.

In this way, the ECHO model is not traditional telemedicine where the specialist assumes patient care but instead a guided practice model where the primary care provider retains responsibility for managing the patient.

Providers practicing in rural areas have similar workforce shortages and fewer resources, such as social workers or therapists, and these sessions have allowed for innovative solutions, Troy Jorgensen, senior program manager for Project ECHO Nevada, said.

By enabling specialists to serve as mentors and train community providers in clinical areas previously outside their expertise, primary care providers can operate with increased independence as their skills and self-efficacy grow.

According to post-session evaluations since 2017, 91.9 percent of ECHO participants either strongly agree or agree that their participation has decreased their sense of professional isolation.

These sessions can help providers feel not so alone in what can be a really lonely environment, Dr. Lavi said. It lets them know other people are dealing with the same challenges in other communities.

Housed within the Office of Statewide Initiatives, Project ECHO Nevada connects everyone that works in health care from primary care providers and specialists to community health workers and administrative partners. Dr. Lavi said the program is proving particularly impactful in rural areas.

The University of Nevada, Reno School of Medicine (UNR Med) proactively addresses these health care challenges by retaining medical school graduates and recruiting medical residents to work in Nevada. Among the initiatives aimed at filling the health care void is Project ECHO.

ECHO is giving physicians and other providers direct access and support to a specialist where they can consult on cases and feel connected to a larger community, Dr. Lavi said.

Thats the vision that Sanjeev Arora, M.D., founded the virtual program on nearly 20 years ago. Now Project ECHO director at the University of New Mexico, Dr. Arora would see patients from rural areas, some suffering from diseases in advanced stages that could have been treated sooner.

These experiences led Dr. Arora to develop Project ECHO. The virtual program adheres to four guiding principles:

As physicians and other providers participate in ECHO, they get feedback and reinforcement about their practice, Dr. Lavi said. These are conversations physicians often dont get to have after residency due to time, workload or proximity to other health care providers.

As Project ECHO continues to grow and evolve, UNR Med remains committed to improving access to health care and enhancing the quality of life for individuals in rural Nevada. In 2024, the program plans to add more learning sessions on topics such as diabetes, pediatrics and rheumatology and increase its outreach and impact.

Ultimately, we're really trying to make improve health at the population level, meaning patients health is improving, Dr. Lavi said. That takes changing providers practices, and ECHO is the force multiplier that we can use to make those changes.

Learn more about Project Echo

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Project ECHOs digital prescription for rural health disparities - University of Nevada, Reno

LINCOLN Near the halfway point of this years legislative session, every Nebraska lawmaker has named their personal priority bill that will set the tone for the remaining 31 days.

Roughly a dozen state senators named health care issues as their priorities, while several others emphasized workforce development and tax reform. Also among the priority bills are a handful that may foreshadow a return to the rancorous debates seen last year.

Lawmakers had until Thursday to name their one personal priority bill for the session. Legislative committees had the same deadline to name up to two priority bills, and over this weekend, Speaker of the Legislature John Arch is considering what 25 bills will be his speaker priorities for the year.

Priority bills are generally given preference by the speaker when scheduling the daily agendas for floor debates. Now that all individual and committee priority bills have been named, Arch said those measures will start coming up more frequently.

From here on out, it will almost exclusively be priority bills on the floor, Arch said.

Health care rose to the top as one of the most popular subjects prioritized this session, including bills to close an insurance loophole for colonoscopies, establish a prescription drug donation program, and expand services for mothers at risk of adverse birth outcomes.

Leading into the session, many lawmakers pinned tax reform and workforce development solutions such as affordable housing, education and child care improvements as top issues for the Legislature to focus on this year.

Those issues came up on the priority list as well, particularly among committee priority bills. Among individual priorities, however, they were a bit more scarce. There is a bill from State Sen. John Fredrickson of Omaha to subsidize child care for child care workers, a bill from Sen. Robert Clements of Elmwood to eliminate the inheritance tax, and a bill from Sen. Danielle Conrad of Lincoln to eliminate barriers to obtaining work licenses.

Conrad said she considers the high number of health care bills as part of the push to pass workforce development proposals. She said that health care is directly tied to workforce challenges and that the prioritized health care bills would help Nebraskas working families.

Overall, Conrad said she was happy with what bills were prioritized this year, saying they help reset the tone from the drama-filled debates that ate up much of last years session. Lawmakers are leaning back into the Legislatures nonpartisan structure, she said, which helps with collaboration on policies that will help Nebraskans most.

Its how its supposed to be in the Nebraska Legislature, Conrad said.

However, there are still several priority bills that are likely to turn into a fight if they make it to floor debates. Most notably, there is Legislative Bill 575, dubbed the Sports and Spaces Act, introduced and prioritized by Sen. Kathleen Kauth of Omaha. The bill would restrict access to K-12 school bathrooms and locker rooms on the basis of biological sex and would add similar restrictions to most school sports teams.

Last year, Kauth prioritized LB 574, which restricted access to gender-affirming care for people under 19. An amendment late in the session also tightened Nebraskas abortion restrictions to 12 weeks, and the combination measure passed. It was the most contentious bill of the session, and was the reason for a session-long filibuster led by one of the bills opponents. Kauth said she expects LB 575 to also be filibustered if it gets to the floor.

The bill has been stuck in committee since last year, but Kauth said she isnt concerned. She said lawmakers are holding the bill in committee until the Legislature gets closer to all-day floor debates, which begin in March. That way, if the bill gets filibustered, its less likely to take up multiple days for each of its three rounds, she said.

Arch said he plans to spread out the controversial priority bills in his agenda scheduling, mixing simpler bills in between to give lawmakers time to negotiate. Part of the challenge of the speakers job, he said, is anticipating how much time is needed for each agenda item.

You cant just back up difficult bills and run them back to back, Arch said.

Another possible floor fight is expected on LB 1009, introduced and prioritized by Sen. Merv Riepe of Ralston. The bill would adjust the abortion restrictions passed last year to add an exception for cases of fatal fetal anomalies, and clarify that women who receive abortions cannot be charged with criminal penalties.

Riepe proposed a 12-week abortion ban last year as an amendment to a measure that would have set Nebraskas abortion restrictions at six weeks. After that bill failed, other senators drafted an amendment to add a 12-week abortion ban to LB 574. Riepe voted to support it, but he says he didnt like the legislation that passed and blames himself for not working harder to fix it.

Riepe has made it clear that LB 1009 doesnt relate to elective abortions, but instead makes it possible for expectant mothers to receive abortions if two physicians agree that her pregnancy isnt viable. He said many women dont learn about fatal fetal anomalies until after the 12-week mark, and says it isnt fair to expect them to carry their pregnancies to term when they know the outcome.

State government is not the place to have a law on this, Riepe said.

Although Riepe framed his bill as a reasonable alternative between easing Nebraskas abortion laws and restricting them further, he said he doesnt expect to see much support from either side of the debate. Sen. Joni Albrecht of Thurston, who has led the charge for increased abortion restrictions in the Legislature, has said she opposes LB 1009, but Riepe said he hopes to find support from other conservative lawmakers.

Other highlights of this years priority bills include:

Obscenity LB 441, introduced and prioritized by Albrecht, would repeal an existing exemption from prosecution, thus making it possible for people working in K-12 schools to be charged with a misdemeanor if they provide obscene materials to minors.

Felons LB 20, introduced by Sen. Justin Wayne of Omaha and prioritized by Sen. Jane Raybould of Lincoln, would restore voting rights for people convicted of felonies once they complete their sentence.

Sex trafficking Constitutional amendment, LR 277CA, introduced and prioritized by Sen. Rita Sanders of Bellevue, would give Nebraska voters the opportunity to set a minimum life sentence for people convicted of sex or labor trafficking of a minor. All constitutional amendments, once passed by the Legislature, are put on the ballot and require voter approval before taking effect.

Scholarships LB 1402, introduced and prioritized by Sen. Lou Ann Linehan of the Omaha area, would appropriate $25 million to be distributed in grants to scholarship-granting organizations that help students attend private and parochial schools.

Last year, Linehan introduced LB 753, which appropriated funds for tax credits to go to individuals and entities that donated to similar scholarship-granting organizations. That bill, which eventually passed the Legislature, is facing a possible repeal through a voter referendum, but LB 1402 would nullify that effort. Linehan said if LB 1402 passes, she would support a repeal of LB 753.

National Guard LB 1394, introduced and prioritized by Sen. Tom Brewer of Gordon, would exempt Nebraska National Guard members from income taxes they incur through payments they received on duty.

Nebraska State Poet Matt Mason poses for a portrait in his home in Omaha on Wednesday, Feb. 7, 2024.

Omaha Bryan's Abdrirahman Unle jumps into the arms of coach Jason Susnja after pinning North Plate's Tyler Haneborg for during the Class A 113-pound championship match at the CHI Health Center in Omaha on Saturday, Feb. 17, 2024.

Omaha Skutt's Kaylyn Harrill, left, wrestles Columbus Lakeview's Lacy Lemburg during the Girls 120-pound championship match at the CHI Health Center in Omaha on Saturday, Feb. 17, 2024.

Millard West's Enrique Haynes celebrates his win over Omaha Creighton Prep's Presden Sanchez in the Class A 120-pound championship match at the CHI Health Center in Omaha on Saturday, Feb. 17, 2024.

Auburn's Ayden Smith, facing, and Bennington's Lane Welchert compete in the first round of the Class B 106-pound match in the state wrestling championships at the CHI Health Center in Omaha on Thursday, Feb. 15, 2024.

Grand Island's Kim Gonzalez, right, and Pierce's Maggie Painter compete in the first round of the girls 120-pound match in the state wrestling championships at the CHI Health Center in Omaha on Thursday, Feb. 15, 2024.

Battle Creek's Ashton Kuchar, facing, and Hi-Line's Parker Schutz compete in the second round of the Class C 126-pound match in the state wrestling championships at the CHI Health Center in Omaha on Thursday, Feb. 15, 2024.

Omaha North's Joshyonna Coppage-Dortch and Chadron's Josey Werner compete in the first round of the girls 100-pound match in the state wrestling championships at the CHI Health Center in Omaha on Thursday, Feb. 15, 2024.

Beatrice's Tristan Reinke, left, wrestles Bennington's Brodee Scobee during the first round of the Class B 132-pound match during the state wrestling championships at the CHI Health Center in Omaha on Thursday, Feb. 15, 2024.

Lincoln North Star's Colton Hauschild celebrates his win over Bellevue East's Dillon Ginter during the first round of the Class A 165-pound match during the state wrestling championships at the CHI Health Center in Omaha on Thursday, Feb. 15, 2024.

Hershey's Ethan Elliott, right, tries to pin North Bend Central's Zac Mullally during the first round of the Class C132 -pound match during the state wrestling championships at the CHI Health Center in Omaha on Thursday, Feb. 15, 2024.

Iowa's Caitlin Clark (22) reacts while answering questions from the media in the post game press conference after the Hawkeyes were defeated by Nebraska, 82-79, at Pinnacle Bank Arena in Lincoln on Sunday, Feb. 11, 2024.

Nebraska's Alexis Markowski (40) embraces her father, Andy, after the Huskers defeated Iowa, 82-79, at Pinnacle Bank Arena in Lincoln on Sunday, Feb. 11, 2024.

Nebraska players celebrate with fans after defeating Iowa, 82-79, at Pinnacle Bank Arena in Lincoln on Sunday, Feb. 11, 2024.

Nebraska's Jacob Van Dee celebrates his win over Michigan's Dylan Ragusin during a 133-pound match at the Bob Devaney Sports Center in Lincoln on Friday, Feb. 9, 2024.

Nebraska's Caleb Smith picks up Michigan's Michael DeAugustino during a 125-pound match at the Bob Devaney Sports Center in Lincoln on Friday, Feb. 9, 2024.

Nebraska's Caleb Smith top. wrestles Michigan's Michael DeAugustino during a 125-pound match at the Bob Devaney Sports Center in Lincoln on Friday, Feb. 9, 2024.

Community members and politicians walk along 24th Street during a Martin Luther King Jr. Keep the Dream Alive March in Omaha on Saturday, Feb. 10, 2024. The walk was postponed by weather from MLK Day in January.

The sun rises over Lake Wanahoo outside Wahoo on Sunday, Jan. 21, 2024.

David Wright, of Bellevue, and his son Michael Wright, of Papillion, ice fish in an insulated shelter on Lake Wanahoo outside Wahoo on Sunday, Jan. 21, 2024. You can spend time with your friends, family," David Wright said. "Its not so much about the fishing."

Creighton's Steven Ashworth (1) wipes the sweat from his face late in the second half against Butler at CHI Health Center Omaha on Friday, Feb. 2, 2024.

Butler's Augusto Cassi (0), left, and Finley Bizjack (13) celebrate an upset of Creighton at CHI Health Center Omaha on Friday, Feb. 2, 2024.

Butler's Jahmyl Telfort (11), left, and Andre Screen (23) try to steal the ball from Ryan Kalkbrenner (11) at CHI Health Center Omaha on Friday, Feb. 2, 2024.

Creighton's Steven Ashworth (1) celebrates a three-point basket against Butler at CHI Health Center Omaha on Friday, Feb. 2, 2024.

Butler's Finley Bizjack (13) chases a loose ball in the second half against Creighton at CHI Health Center Omaha on Friday, Feb. 2, 2024.

Creighton's Baylor Scheierman (55), right, helps Ryan Kalkbrenner (11) after they lost to Butler at CHI Health Center Omaha on Friday, Feb. 2, 2024.

Creighton fans react to a Butler basket in the second half at CHI Health Center Omaha on Friday, Feb. 2, 2024.

Omaha's Marquel Sutton (10) gets ready for a shot against St. Thomas at Baxter Arena in Omaha on Thursday, Feb. 1, 2024.

Omaha takes on St. Thomas at Baxter Arena in Omaha on Thursday, Feb. 1, 2024.

Omaha's Marquel Sutton (10) looks to pass the ball around St. Thomass Brooks Allen (4) at Baxter Arena in Omaha on Thursday, Feb. 1, 2024.

Looking north on 13th Street from Hickey Street in the Little Bohemia neighborhood toward downtown Omaha.

Doug Harold works at the Tomasek Machine Shop located at 1631 S 13th St.

Doug Harold works at the Tomasek Machine Shop located at 1631 S 13th St.

Wrestlers warm up with jump ropes during practice at Omaha Bryan High School in Omaha on Thursday, Feb. 1, 2024. Omaha Bryan will be in the state duals for the first time in program history

ebamer@owh.com Twitter @ErinBamer

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Priority bills in Nebraska Legislature aim at health care - Omaha World-Herald

Plain and simple people get sick.

Right now, more than 250,000 predominantly low-income Montanans get help with healthcare through Medicaida state-federal partnership. Montana has overall and primary responsibility, while the Feds pick up most of the costs, averaging 80% (of total Medicaid spending). In 2022, the Federal government provided $1.8 billion to cover health care for Medicaid-eligible Montanans who live in every county across the Big Sky. Remarkably, two-thirds of Medicaid recipients live in our rural communities.

So, what is Medicaid, and who does it serve?

Not only does Medicaid fund health care services for our lower-income neighbors including children, families, and pregnant moms, but it also covers those with serious disabilities. By reducing the number of uninsured, Medicaid has also helped keep healthcare insurance costs down for everyone while pumping money into Montanas economy. The Medicaid reimbursements for rural and urban healthcare providers keep the doors of healthcare facilities open and help retain healthcare providers. Small businesses also benefit from Medicaid, as they often cannot afford to provide health insurance for their employeeswhether they work full or part-time.

Medicaid Expansion is a critical program for our Native American Montanans. The Indian Health Service continues to be woefully underfunded; a recent series of newspaper articles illustrates the healthcare challenges facing those who reside on reservations. Medicaid has greatly boosted services to Native Americans, allowing them to access a broader range of healthcare providers. The federal government reimburses the care provided to Native Americans on Medicaid at 100%.

Despite the benefits of Medicaid, we now have more than 120,000 Montanans18% of kiddoswho have lost Medicaid coverage due to DPHHSs procedural snafus. The end of the COVID public health emergency necessitated each state to review eligibility for Medicaid. Thats reasonable; however, Montana launched a process that is difficult, confusing, and sometimes impossible for people to reapply or maintain eligibility. The result: Almost one-in-every-three Medicaid recipients has been denied not because of eligibility, but 64% for technical or procedural issues. Montana now has among the highest and worst records in the nation for terminating health insurance for children. Disgraceful.

Reports indicate 4- to 6-hour telephone waits and multiple tries for Medicaid recipients to provide documentation to keep their insurance. Unbelievably, some folks did not know their coverage had been terminated until they arrived at the doctors office. What happened to Gov. Greg Gianfortes political promises of less bureaucracy?

Alarmed by Montanas record, federal healthcare authorities have twice requested changes to this processechoing a chorus of local healthcare providers (such as the Montana Chapter of the American Academy of Pediatricians) asking for a 30-day pause to stop children from losing their coverage. Meanwhile, state officials seem hell-bent on purging the Medicaid rolls, to the detriment of peoples health as well as our economy.

Is this purging a signal of things to come? Medicaid Expansion must be renewedduring the 2025 legislative session. Montanas Medicaid program is not plagued by fraud and abuseexactly the opposite. Its bewildering to think about the consequences of this purge. Ironically there is an ongoing major mental health reform initiative, aimed at expanding access. Yet, many of those losing Medicaid need mental or behavioral health servicesbut will no longer be eligible.

The governor is taking Montana backward, not forward Is this the Montana we want for our children, those less fortunate, or folks in rural areas?

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Let's set the record straight on Montana's Medicaid Daily Montanan - Daily Montanan

Massachusetts Governor Maura T. Healey 92 is under increasing pressure to address the financial crisis facing Steward Health Care, which operates nine hospitals statewide including the Brighton-based St. Elizabeths Medical Center.

Healey will speak to the Public Health Council Wednesday morning about the crisis, her spokesperson Karissa Hand wrote in an email, amid mounting questions about whether Steward can find a buyer to assume ownership of some of its hospitals.

A Boston Globe investigation last month revealed the health care system was tens of millions behind on rent, making some of its hospitals vulnerable to service reductions or closures.

If St. Elizabeths were to close, it could have immense ramifications for both Allstons economy and the health of its residents, said Anna Leslie, executive director of the Allston Brighton Health Collaborative.

Not only is it the largest healthcare provider in the neighborhood, it's the largest employer in the neighborhood, Leslie said.

In an email to The Crimson, a spokesperson for Boston Mayor Michelle Wu 07 wrote that city officials are in contact with the state and unions and are monitoring the situation closely.

Paul Hattis, a former member of the state Attorney Generals Health Policy Commission, said Healeys administration has several options at its disposal, although at the moment, the ball seems to be in Stewards court. Those options include a court-appointed receivership, inspection of Stewards hospitals, or helping finance the sale of the hospitals to other regional healthcare groups.

The state could also bail out the company, a possibility Healey has publicly dismissed. In a statement on Feb. 2, the Executive Office of Health and Human Services announced they are conducting daily on-site monitoring visits at St. Elizabeths and two other hospitals to evaluate day-to-day staffing, supplies, and patient count.

EOHHS also said they were working to determine the patient capacity of other health care providers in the state, suggesting the administration is taking steps to prepare for the possibility of hospital closures.

On Feb. 2, Steward claimed to have secured enough financing to keep all its Massachusetts hospitals open while it looks for new owners of some of its hospitals. Still, some prominent state lawmakers including House Speaker Ron Mariano, a Quincy Democrat, remain suspicious of the health care giant, which has not released the details of its bridge funding plan.

Leslie said the crisis at Steward could have been foreseen well in advance.

St. Elizabeths had failed to pay $150,000 it owed to the ABHC as part of a non-binding community benefits agreement, Leslie said in an interview Tuesday morning. Later on Tuesday, St. Elizabeth paid the $50,000 it owed the ABHC for 2023, Leslie wrote in an email Tuesday night.

Its troubling that it got this far, Leslie said. There were a lot of warning signs directly from staff, from community partners like us.

A spokesperson for St. Elizabeths did not respond to a request for comment. In an email, Caroline Whitehouse, a spokesperson for the EOHHS wrote that Healeys administration had been in communication with Steward over its finances for months.

Hattis said Steward has exhibited a pattern of failing to disclose information about its finances to the state. Steward sued the state Center for Health Information and Analysis in 2016 to prevent the handover of their financial statements.

By that point, the health care giant had been fined hundreds of thousands of dollars in fines for refusing to disclose required financial data to the state.

In Boston, the City Council will hold a hearing on the Steward crisis on Thursday, Feb. 22, which will include testimony from members of the public.

Staff writer Jina H. Choe can be reached at jina.choe@thecrimson.com.

Staff writer Jack R. Trapanick can be reached at jack.trapanick@thecrimson.com. Follow him on X @jackrtrapanick.

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Healey Under Pressure to Address Steward Health Care Crisis, Brighton Hospital At Risk | News - Harvard Crimson

Rep. Ashley Hinson

One of my top priorities in Congress is ensuring Iowans in rural areas have the same access to health care as those in urban areas. As Ive traveled throughout Eastern Iowa, I have seen firsthand the ways rural Iowans are stepping up to improve access to quality health care, especially maternal care.

As a mom, expanding access to maternal care is personal to me. When youre pregnant, you have a million thoughts going through your head. Stressing about being able to see your doctor or get the care you need should not have to be one of them.

I am committed to advancing bipartisan initiatives to ensure women in rural areas have the support and care they need for their health and the health of their babies.

The Midwives for Moms Act: Legislation that will help increase the number of trained midwives in the United States to help fill gaps in maternity care and improve birth outcomes.

The No Surprise Bills for New Moms Act: Legislation that prevents new parents from receiving surprise medical bills for their newborn babies.

The Maternal and Child Health Stillbirth Prevention Act: Legislation that helps prevent the all too frequent, but often silent, tragedy of stillbirth and save the lives of mothers and babies.

Last week, I spent time with maternal care providers and with women who shared their experiences with high risk pregnancies and stillbirths. I will bring their stories with me to Washington as I continue the fight for better care.

It was great to join the Mason City Chamber for their Breaking Glass Leadership series last week. From the importance of prioritizing family time to sharing how I stay grounded in D.C., I enjoyed sharing my experience as a working mom and the lessons Ive learned throughout my time in public service.

It was great to meet with All About Cheesesteaks owner, Joe. I heard about how he successfully grew his operation from food truck to storefront, or as he calls it, wheels to walls.

If youre in Charles City, be sure to check them out and grab a delicious cheesesteak.

The team at the MercyOne New Hampton Medical Center is exceptional. We discussed the steps theyve taken to ensure expecting mothers can receive prenatal care and the importance of expanding access to health care for new moms and their babies

Peoples Clinic provides a wide array of health care services to residents of Butler County. It was great to learn more about their successful model and see firsthand their passion for providing high quality care to everyone who walks in their doors

Iowa raises 12 million turkeys each year, ranking 7th nationwide for turkey production. Thank you to The Iowa Turkey Federation, Kim Reis, and USDA Wildlife Services for facilitating a tour and the informative discussion about the importance of mitigating bird flu.

I sat down with women who have endured high-risk pregnancies and the tragedy of stillbirth in Grundy County. These women have leaned on each other throughout their difficult journeys to motherhood and I am so inspired by their strength.

It was heartbreaking to hear their stories of immense loss, but Im so grateful they are willing to lend their voices and experiences to the fight for better maternal care.

Im more motivated than ever to fight for healthy moms and healthy babies.

Link:

Ensuring access to health care - Southeast Iowa Union

Peter Buckley, MD, chancellor of the University of Tennessee Health Science Center, will deliver his State of the University presentation Wednesday, February 21, at 11 a.m. CST, on the Memphis campus in the Mooney Library, Room 201.

The theme of the presentation is Tennessee is Our Campus,emphasizing UT Health Science Centers statewide presence and impact. The university trains the majority of the health care workforce for Tennessee and provides care through faculty physicians and other health care professionals and more than 1,400 residents at partner hospitals across Tennessee.

UT Health Science Centers main campus is in Memphis, where it has longtime clinical and educational partnerships with hospitals, including Regional One Health, Le Bonheur Childrens Hospital, Lt. Col. Luke Weathers, Jr. VA Medical Center (formerly the Memphis Veterans Affairs Medical Center), St. Jude Childrens Research Hospital, Baptist Memorial Healthcare, Methodist Le Bonheur Healthcare, and St. Francis Hospital, as well as multiple specialty clinics, physician practice groups, community, and public health programs. The university also has campuses in Nashville, Knoxville, and Chattanooga, with clinical and educational partnerships at major hospitals, including Ascension Saint Thomas Hospital in Nashville, Erlanger Health System in Chattanooga, the University of Tennessee Medical Center in Knoxville, and West Tennessee Healthcare Jackson Madison County Hospital in Jackson, as well as more than 880 clinical and educational training sites in communities across Tennessee, all supported through strategic partnerships.

The presentation will belive streamed. For those who cannot watch the live event, a recording will be available after the presentation on theMessages from the Chancellor web page.

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UT Health Science Center 'State of the University' Presentation Feb. 21 - UTHSC News - UTHSC News

Two weeks after the patients death on Sept. 13, state health inspectors arrived at the hospital, owned by for-profit Steward Health Care, to investigate. During their review of patient records, they found an emergency department with recurring staffing problems that at times seemed to be in near-meltdown.

Extremely sick patients had no assigned nurses, including one patient who was previously found unresponsive in a hallway. In another instance, an overworked nurse who was extremely busy and was behind, trying to catch up left a patient who had been vomiting in the waiting room for more than 10 hours. A friend discovered the patient barely conscious; the person was intubated and admitted to the intensive care unit, according to a state inspection report. It is unclear from the report if those patients survived, and hospital officials declined to provide that information.

State and federal officials declared the safety lapses put patients in immediate jeopardy, a severe sanction that required Good Samaritan to develop a plan within 23 days to fix its emergency department or risk losing its Medicare funding. Good Samaritan executives said they addressed the problems immediately, including bringing in more staff.

The hazards in the hospitals emergency department should not have been a surprise to state and federal regulators. Inspectors for the Massachusetts Department of Public Health had found serious patient safety violations in Good Samaritans emergency department three other times since 2021, documents obtained by the Globe show. After each inspection, investigators required the hospital to produce an improvement plan, but their visits resulted in little lasting change.

It wasnt until Jan. 31, when the seriousness of the financial crisis engulfing the company had become public, that the health department began sending daily monitors to Good Samaritan and other Steward hospitals, raising concerns about why the state didnt do more sooner.

While emergency departments are under strain across Massachusetts and the country, staff at Good Samaritan have been especially overwhelmed as they try to treat thousands of additional patients after two nearby hospitals shut their doors. At the same time, nurses have told state inspectors that private equity-backed Steward has neglected to hire enough staff and buy enough supplies.

The Massachusetts Nurses Association, the union that represents nurses at the hospital, warned state and federal health officials in 2021 and 2022 about the deterioration of the emergency department. Among the problems they cited: the potentially avoidable deaths of two patients, patients without nurses, patients being left in the waiting room for hours without being reevaluated, and managements failure to follow through on its promises, according to a letter and a memo obtained by the Globe.

Last March, emergency room nurses spoke directly to Governor Maura Healey, Lieutenant Governor Kim Driscoll, and Secretary of Health and Human Services Kate Walsh about their concerns when Massachusetts officials visited Good Samaritan after a fire shut down nearby Brockton Hospital.

In September, on the day the patient died while in the registration line, 19 nurses were supposed to be on duty, according to an internal staffing report. There were eight.

Dr. Robbie Goldstein, commissioner of the state Department of Public Health, said the patients death was a tragic event and for all us it really gave us significant pause. But he said inspectors have provided close oversight of the Good Samaritan emergency department since 2021; the department thoroughly investigated every complaint, required an improvement plan, and revisited the hospital once after each plan was submitted to ensure its implementation, he told the Globe.

He acknowledged the department did not send in regular monitors until two weeks ago, but said that step has traditionally been taken only during nursing strikes.

Do I think that we will change the way that we provide oversight, evaluate facilities, and intervene at times of financial distress? Absolutely. That story is being written right now, Goldstein said.

He said he recognizes the situation at Good Samaritan and other Steward hospitals is hard for patients and Steward staff. We are working 24/7 with Steward and with the rest of health care to make sure that we can address the challenges that people are facing, he added.

The inspections of Good Samaritan were conducted by state officials on behalf of the US Centers for Medicare and Medicaid Services, which issues reports called statements of deficiencies when it finds problems. Those reports include descriptions of incidents but not patients names or other identifying details.

In a statement emailed to the Globe, Good Samaritan president Matt Hesketh said that after the immediate jeopardy findings on Sept. 26 and 28, the hospital immediately hired technicians to help assess the vital signs of patients in the waiting room, and deployed nurse practitioners and physician assistants to help triage walk-in patients steps that were part of the improvement plan. The hospital also is offering $40,000 signing bonuses to nurses hired to work in the emergency department.

Inspectors from the Centers for Medicare and Medicaid Services recently visited the hospital and we remain in full compliance with all guidelines and protocols, Hesketh said.

We have faced unprecedented challenges over the past few years, however, the safety of our patients and providing excellent, compassionate care is our focus day in and day out, he added.

Goldstein, however, said that monitors stationed at Good Samaritan and other Steward hospitals have received additional complaints about patient care, and that the department is investigating the allegations. He did not describe the nature of them.

Experts in emergency medicine and patient safety consulted by the Globe could not assess whether the issues at Good Samaritan were more severe than elsewhere.

Theres a lot of bad things there, said Dr. Joseph C. Tennyson, president of the Massachusetts College of Emergency Physicians, an advocacy group for doctors, after being told of the reports. But he added, Bad things like this are happening everywhere right now because the capacity doesnt exist.

Just two weeks ago, the state Department of Public Health designated hospitals in Greater Boston and north of the city as Tier 3, meaning they have a high risk of capacity problems throughout their hospitals and need to meet more frequently with health officials and one another to coordinate patient load. Good Samaritan and other hospitals south of Boston have been in Tier 3 for the past year, after Brockton Hospital closed.

Patients have suffered because of delays at other hospitals. A disabled patient became unresponsive in the emergency department waiting room at Cooley Dickinson Hospital in Northampton in November 2022, during a six-hour wait for care. He died several hours later.

The patient, a 74-year-old man, checked in about 8:30 p.m. complaining of a cough and other respiratory symptoms. The triage nurse ordered lab tests and a chest X-ray and sent him to the waiting room, but failed to measure his blood oxygen level, according to a state inspection report. Another nurse told inspectors the triage nurse was running behind and there were too many patients waiting to be triaged. When his guardian the man was disabled, according to a relative told staff he did not look well, they found him unresponsive. Death records show he had the flu and pneumonia, and died of sepsis.

Laura Oggeri, a spokesperson for Mass General Brigham, which owns Cooley Dickinson, said that she could not discuss a specific case due to patient confidentiality rules, but that the hospital now requires mandatory additional medical reassessments for those waiting for care.

While many emergency departments are struggling with severe overcrowding amid a national shortage of nurses, they differ in how effectively they respond, said Barbara Fain, executive director of the Betsy Lehman Center for Patient Safety, a Massachusetts state agency.

We do know that there is wide variability in the safety cultures of different hospitals, and that is really driven by the leadership, she said.

Dr. Zirui Song, associate professor of health care policy and medicine at Harvard Medical School, said the circumstances at Good Samaritan might be attributable to staffing reductions. A study he and others published in December found that after hospitals are acquired by a private equity company, they experience a 25 percent increase in adverse events, such as infections and falls. This is happening even as other hospitals are seeing a decline in such events, he said.

One of the primary hypotheses that we have is that staffing reductions after a private equity acquisition might explain these findings, Song said, and that might apply as well to the emergency department.

Song, an internist at Massachusetts General Hospital, called what happened to patients at Good Samaritan gut-wrenching and heart-breaking and not something he would expect to see at Mass. General, even when the emergency department is extremely busy. Patients with chest pain and shortness of breath are typically worked up fairly rapidly, he said.

So the fact the E.D. is full does not mean that these adverse events . . . are acceptable or expected, he said.

But sometimes they are unavoidable, said Tennyson, the emergency physicians group president. As an emergency department physician, he said, he has seen patients designated ESI 2 the second most severe level of patient illness who have waited 14 hours or longer. Ideally a patient with chest pain would be seen right away and get an electrocardiogram, a recording of the hearts electrical activity that can help diagnose a heart attack, within 10 minutes, said Tennyson, who is chief of emergency medicine at UMass Memorial HealthAlliance-Clinton Hospital.

But its not uncommon for a chest pain patient to have to wait in a busy ER, because there are five or six people or more that are having chest pain, and most of them are not having a heart attack, Tennyson said.

Those situations are painful and demoralizing for the staff, he said.

To see somebody in the waiting room that you absolutely know you need to go see, that you need to get seen right away, and theres no way to do it thats injurious and its contributing to burnout, he said.

Liz Kowalczyk can be reached at lizbeth.kowalczyk@globe.com. Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her @felicejfreyer.

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Steward Health Care news: ER near Boston put patients in jeopardy - The Boston Globe

As mental health awareness gains momentum globally, healthcare companies are emerging with progressive healthcare solutions. With a keen focus on breaking down barriers to accessing quality mental health services, Sukoon Health recently introduced cashless insurance coverage for psychiatric inpatient care. This initiative comes as a response to the pressing need to address mental health issues effectively.

To explore the intricacies of Sukoon Health's approach, ETHealthworld's Rashmi Mabiyan Kaur interacted with Co-Founder & Chief Growth Officer Vidit Bahri on the company's vision, collaborative efforts, and the transformative impact they aim to achieve in the landscape of mental healthcare in India. Edited excerpts:

Q: What challenges around mental health can the insurance plan address? The persistent stigma surrounding mental health in Indian society often deters individuals from seeking assistance or openly discussing their mental health issues. Moreover, the prolonged treatment and support required for serious mental health disorders can impose significant financial strain on individuals and families. However, Sukoon Health's insurance plan, encompassing a wide array of treatment options such as therapy, medication, and rehabilitation services, facilitates seamless continuity of care. This comprehensive coverage not only supports individuals throughout their recovery journey but also alleviates the financial burden associated with long-term mental health treatment.

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How Sukoon Health aims to revolutionize psychiatric care with cashless insurance - ETHealthWorld

AI-powered care facility automation platform care.ai announced an enterprise-wide partnership with New Jersey-based not-for-profit hybrid care provider Virtua Health, where Virtua will leverage care.ai's virtual care offerings, including its Smart Care Facility Platform and Always-Aware ambient sensors.

care.ai's Smart Care Facility Platform includes a network of sensors spread through a care facility that monitors patients using AI, allowing the facility to collect real-time behavior data for clinical and operational insights.

The Florida-based company's AI-powered offerings will initially be utilized at Virtua Our Lady of Lourdes Hospital in Camden, New Jersey, then eventually implemented in all of Virtua Health's acute care settings.

The announcement comes approximately two months after the partners launched a pilot Virtual Nurse program in a medical-surgical unit that allows remote and bedside nurses to work in tandem.

Patients could also communicate with a nurse via a two-way optical camera, and their family members could participate in the calls remotely.

"Our focus is not just on integrating cutting-edge technologies but on enhancing the human aspects of healthcare. By swiftly adopting optical cameras and ambient sensors, we're poised to markedly enhance the patient and care team experience, ensuring a safer, more efficient, and empathically connected healthcare experience," Michael Capriotti, senior vice president of integration and strategic operations at Virtua Health, said in a statement.

THE LARGER TREND

In 2022, care.ai scored $27 million in funding led by multi-asset investment firm Crescent Cove Advisors.

Last year, the company announced it was partnering with Colorado-based remote patient monitoring company BioIntelliSense to integrate BioIntelliSense's BioButton wearablea product used for continuous vital-sign monitoring for 60 days that captures temperature, respiratory rate and heart rate at rest into its Smart Care Facility Platform.

care.ai also announced a partnership with the Texas Hospital Association to create statewide adoption of AI-powered patient monitoring and a partnership with patient engagement platform Get Well, which allows patients to connect with care teams via the interactive TV platform already present in patient rooms.

In June, care.ai announced it was partnering with multinational electronics company Samsung to integrate its Smart Care Facility Platform into the tech giant's displays for use by health systems, allowing for AI-powered patient monitoring.

Clinical care teams could also attend virtual visits over care.ai devices paired with Samsung's displays.

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care.ai, Virtua Health partner to expand the hybrid care providers' virtual care offerings - Mobihealth News

It was only after the death of her husband in 2018, a year after their children sponsored their immigration to the U.S. from Venezuela, that Tatijana Kowalchuk began paying attention to the dizziness that made walking a challenge and shaking hands that made her writing a mess.

And so did the staff at Richmonds Health Brigade free clinic, who found a nearly quarter-inch tumor pressing on her brain.

The staff at Richmonds Health Brigade free clinic found a nearly quarter-inch tumor pressing on Tatijana Kowalchuk's brain. The clinic continues to offer her care and support.

She did not have the money to do anything about it and these days, Virginias free clinics are short of the resources they need to help people who, like the Kowalchuks, fall between the many cracks in the American health care system, which is why Del. Betsy Carr, D-Richmond, and state Sen. Barbara Favola, D-Arlington, are asking the General Assembly to lend a hand.

At the clinic, once staff found treatment for the usual explanation of dizziness middle ear problems was not helping Kowalchuk, they quickly arranged for a neurologist to examine her, free of charge, as well as for the MRI scan that found the tumor.

It was big; the surgery would cost a lot, Kowalchuk said. Health Brigade stepped in again, working long-nurtured connections with surgeons and hospitals to arrange the operation, again free of charge, and to negotiate a discount and payment plan for Kowalchuk to afford follow-up scans.

Tatijana Kowalchuk and medical case manager Robert Key talk at Health Brigade in Richmond on Feb. 13 about how much they mean to each other. Kowalchuk calls Key her guardian angel.

As new, if elderly immigrants, sponsored by their children, the Kowalchuks could not get Medicare and from what they had heard about the cost of health care here, doing something about Wladimiro Kowalchuks cancer scare was a frightening prospect.

Robert was my husbands angel. His guardian angel. He is my angel, said Kowalchuk, referring to the clinics veteran medical case manager, Robert Key, who took the lead helping the couple navigate his cancer treatment and later her surgery.

Virginias 60-plus free clinics provide care to some 75,000 people a year, amounting to some $114 million in 2022. It is a distinctive kind of care, too: focused on all of the needs a patient might have including some that do not always come to mind when people feel they need to see a doctor.

Kowalchuk saw the difference several months after her surgery. She had come back from a trip to her attic with a painful rash on both hands.

I called dermatologists and they said they could give me an appointment in two or three months, she said. The pain is really strong, Id say, but it didnt make any difference.

A visit to a hospital emergency room prompted a suggestion to see a dermatologist. She stumped three doctors at a local doc-in-a-box.

I finally came to Health Brigade, she said.

The nurse looked at my hands and said; Thats an infection the ER doctor said it wasnt that, Kowalchuk said. She said, Ill give you an antibiotic; if it is not better in two days come back and well figure it out. The first day I was a little better; the second day, a lot better.

It is paying attention, maybe even more than being able to offer free access to care, that is the key to what free clinics provide, said Karen Legato, Health Brigades executive director.

We look at the whole person," said Karen Legato, the executive director of the Health Brigade free clinic. "Its not the transactional model."

We look at the whole person ... its not the transactional model, she said.

That means, for instance, making sure a patients electricity is on and that they have enough food. Health Brigade will arrange connection with food pantries, for instance, and can help people access emergency help with utilities to make sure they are warm enough in winter and not overheating in a summer hot spell. If transportation is a problem, case managers and social workers figure out ways to deal with that.

Health Brigades distinctive outreach efforts, like its syringe exchange program, take similar extra steps, when staffers offer COVID-19 and flu vaccinations, clothing in the winter, and assessments of other medical or dental needs as well as a path to getting them treated.

But that whole-person approach, especially in the wake of COVID-19, is swamping Virginias free clinic network.

Coverage through Medicaid was expanded, and all of a sudden, people who werent insured were coming in, Legato said. We had people who didnt know what they had, and we were finding complex, chronic conditions ... and now that Medicaid is going away for them, theyre on our rolls and were taking care of them.

The free clinics compete with hospitals and private practices for physicians, nurses and other medical staff. Staffing accounts for about 80% of Health Brigades budget, for instance free clinics do get a bit of a break on the biggest driver of medical cost increases in other parts of the health care system: prescription drugs.

It takes a big heart to do this, but people need to be paid, Legato said. Even so, a nurse practitioner here may be making 30% less than in private practice.

Theres been a squeeze, too, on the heart of the free clinic model: the volunteers.

COVID-19 kept many away, as clinics tried their best to make sure they did not become hotspots. Statewide shortages in some specialties behavioral health is a particular problem mean many volunteers who used to pitch in cannot find the time and relief from their own patients demand to spare.

That has meant larger paid staffs than had been the pre-pandemic pattern.

Rufus Phillips, CEO of the Virginia Association of Free and Charitable Clinics, said budget amendments proposed by Carr and Favola would offer some relief.

Virginias free and charitable clinics are the backbone of our Commonwealths health care safety net, Carr said in a statement.

With Medicaid unwinding and the end of pandemic relief as well as increased economic pressures disproportionately affecting underserved communities, the need to sustain free clinics has never been greater, she said.

The amendments call for a $5 million-a-year bump in state funds for the clinics, for an annual total of $10.3 million. The current $5.3 million a year was set in 2016, with the idea of covering about 30% of the clinics costs. It currently accounts for about 18%, Phillips said. The clinics operating costs since then have climbed 170%.

If you look at clinics in 2016 and now, youll see big differences, too, Phillips said. Theyre adding dental care, wraparound supports for the social determinants of health; food pantries, even delivering food and showing people how to cook unfamiliar food.

Tatijana Kowalchuk relies on a free clinic Richmonds Health Brigade for care and for support.

And in the end, it is the staff paid and volunteer and the way they see the people who need their services, that make a difference.

So in spotting a concern in Kowalchuks once-every-six-month lab tests for a kidney issue last December, her nurse asked her to come in for another test last month, and with that suggested an every-three-month schedule just to be sure my kidneys are still OK, Kowalchuck said.

You know, they also have a mental health service, she said. Theyve been a real help after my husband died ... I can get down ... I have my daughter and her husband, my neighbor shes very nice but I really dont know many people here.

Brianne Chapman, center, holds up sign near members of the Kekoa Virginia Militia during a Second Amendment Rights rally hosted by Virginia Citizens Defense League on Lobby Day at the state Capitol on Monday, Jan 15, 2024.

Philip Van Cleave, president of the Virginia Citizens Defense League, speaks during a Second Amendment Rights rally on Lobby Day at the state Capitol on Monday, Jan 15, 2024.

Demonstrators march toward the General Assembly building at the state Capitol in support of various bills on Lobby Day, Monday, Jan. 15, 2024. The march was organized by New Virginia Majority.

Demonstrators put down signs before entering the General Assembly building at the state Capitol in support of various bills on Lobby Day, Monday, Jan. 15, 2024. The march was organized by New Virginia Majority.

Demonstrators enter the General Assembly building at the state Capitol in support of various bills on Lobby Day, Monday, Jan. 15, 2024. The march was organized by New Virginia Majority.

Demonstrators enter the General Assembly building at the state Capitol in support of various bills on Lobby Day, Monday, Jan. 15, 2024. The march was organized by New Virginia Majority.

Demonstrators put down signs before entering the General Assembly building at the state Capitol in support of various bills on Lobby Day, Monday, Jan. 15, 2024. The march was organized by New Virginia Majority.

Demonstrators wait to enter the General Assembly building at the state Capitol in support of various bills on Lobby Day, Monday, Jan. 15, 2024. The march was organized by New Virginia Majority.

Assaddique Abdul-Rahman, and organizer with New Virginia Majority, leads a chant during a demonstration in support of various bills outside of the General Assembly building at the state Capitol on Lobby Day, Monday, Jan. 15, 2024.

Assaddique Abdul-Rahman, and organizer with New Virginia Majority, leads a chant during a demonstration in support of various bills outside of the General Assembly building at the state Capitol on Lobby Day, Monday, Jan. 15, 2024.

Demonstrators enter the General Assembly building at the state Capitol in support of various bills on Lobby Day, Monday, Jan. 15, 2024. The march was organized by New Virginia Majority.

Young demonstrators attend a gun safety rally at the state Capitol on Lobby Day, Monday, Jan. 15, 2024.

Demonstrators attend a gun safety rally at the state Capitol on Lobby Day, Monday, Jan. 15, 2024.

Speaker of the House Don Scott, D-Portsmith, speaks to a crowd during a gun safety rally at the state Capitol on Lobby Day, Monday, Jan. 15, 2024.

Demonstrators attend an afternoon gun safety rally at the Bell Tower in Capitol Square on Lobby Day on Monday.

Speaker of the House Don Scott, D-Portsmith, speaks to a crowd during a gun safety rally at the state Capitol on Lobby Day, Monday, Jan. 15, 2024.

Young demonstrators attend a gun safety rally at the state Capitol on Lobby Day, Monday, Jan. 15, 2024.

Demonstrators attend a gun safety rally at the state Capitol.

A demonstrator holds a sign at a gun safety rally at the state Capitol on Lobby Day, Monday, Jan. 15, 2024.

During the Omega Psi Phi Lobby Day session, Senate President Pro Tempore Louise Lucas, D-Portsmouth, responds to questions from Fairfax County resident Robert Fairchild, right, about her priorities for the 2024 General Assembly.

Philip Van Cleave, president of the Virginia Citizens Defense League, speaks during a Second Amendment Rights rally on Lobby Day at the state Capitol on Monday, Jan 15, 2024.

A flag is waved during a Second Amendment Rights rally hosted by Virginia Citizens Defense League on Lobby Day at the state Capitol on Monday, Jan 15, 2024.

Virginians on both sides of the gun debate make their case during Lobby Day at the state Capitol on Monday. Brianne Chapman holds up a sign near members of the Kekoa Virginia Militia during a Second Amendment rights rally hosted by the Virginia Citizens Defense League.

A demonstrator, who goes by Rustpit, stands in front of the Supreme Court of Virginia during a Second Amendment Rights rally hosted by Virginia Citizens Defense League on Lobby Day on Monday, Jan 15, 2024.

Cam Edwards of Farmville speaks at the state Capitol during a Second Amendment rights rally hosted by the Virginia Citizens Defense League.

Del. Delores Oates, R-Warren, speaks during a Second Amendment Rights rally hosted by Virginia Citizens Defense League on Lobby Day at the state Capitol on Monday, Jan 15, 2024.

Brianne Chapman holds up sign near members of the Kekoa Virginia Militia during a Second Amendment Rights rally hosted by Virginia Citizens Defense League on Lobby Day at the state Capitol on Monday, Jan 15, 2024.

A demonstrator holds up a sign during a Second Amendment Rights rally hosted by Virginia Citizens Defense League on Lobby Day at the state Capitol on Monday, Jan 15, 2024.

Members of the Kekoa Virginia Militia hold guns during a Second Amendment Rights rally hosted by Virginia Citizens Defense League on Lobby Day at the state Capitol on Monday, Jan 15, 2024.

Demonstrators hold flags in front of the Supreme Court of Virginia during a Second Amendment Rights rally hosted by Virginia Citizens Defense League on Lobby Day on Monday, Jan 15, 2024.

Demonstrators stands in front of the Supreme Court of Virginia during a Second Amendment Rights rally hosted by Virginia Citizens Defense League on Lobby Day on Monday, Jan 15, 2024.

A demonstrator holds up a sign at the state Capitol on Lobby Day during a gun rights rally hosted by the Virginia Citizens Defense League.

Jason Hazelwood holds a flag in front of the Supreme Court of Virginia during a Second Amendment Rights rally hosted by Virginia Citizens Defense League on Lobby Day on Monday, Jan 15, 2024.

Eddir Garcia, a Republican Senate candidate, speaks to demonstrators in front of the Supreme Court of Virginia during a Second Amendment Rights rally hosted by Virginia Citizens Defense League on Lobby Day on Monday, Jan 15, 2024.

A demonstrator, who goes by Rustpit, stands in front of the Supreme Court of Virginia on Monday during a Second Amendment rights rally hosted by Virginia Citizens Defense League.

Jason Hazelwood holds a flag in front of the Supreme Court of Virginia during a Second Amendment Rights rally hosted by Virginia Citizens Defense League on Lobby Day on Monday, Jan 15, 2024.

Jess Bookout, left, and Leslie Floyd attend Lobby Day to talk about early childhood education.

Virginians stand in the lobby of the General Assembly Building on Monday.

Virginians gathered for Lobby Day at the Virginia General Assembly include People wearing Guns Save Lives stickers in the lobby of the General Assembly Building.

On Lobby Day, Madison Brumbaugh, second from left, vice president of the Speech-Language-Hearing Association of Virginia, speaks with lawmakers, including Del. Michael Jones, D-Richmond, left; Del. Chris Obenshain, R-Montgomery; and Del. Wendell Walker, R-Lynchburg.

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VA's money-squeezed free clinics offer a vital helping hand - Richmond Times-Dispatch

The health care sector is witnessing a significant transformation as private equity (PE) firms step up their acquisition of physician practices. This trend reflects a broader shift within the health care industry of corporate investors acquiring health care providers, driven by the allure of short-term profitability and efficiency gains. It also raises questions about the implications for health care quality, accessibility and the overall impact on the U.S. health care system.

A new study led by Yashaswini Singh, assistant professor of health services, policy, and practice and a member of Browns Center for Advancing Health Policy Through Research, will explore this phenomenon and the effects of PE acquisitions on health care accessibility. Funded by the National Institute for Health Care Management Foundation, the study, Spillover Effects of Private Equity Acquisitions of Physician Practices on Local Market Competitors: Implications for Access to Care, represents a pioneering investigation into a critically under-examined area.

Singhs prior research shows that PE acquisitions of physician practices often lead to increased health care spending and utilization, changes in workforce composition and a reshaping of services based on profitability. Yet the extended impact of these changes, especially the spillover effects on competing practices within the same locale, remains largely unexplored.

Singhs new study will consider a core concern: the propensity of PE firms to prioritize short-term financial gains, potentially at the expense of offering comprehensive care. This strategy may lead to the curtailment or discontinuation of less lucrative services, disproportionately burdening independent medical practices, as they may have to accommodate an increased demand from patients turned away from PE-owned offices.

Singh and her study co-author, Durgar Borkar, assistant professor of ophthalmology at Duke University, are focusing on the field of ophthalmology, merging hand-collected data on PE ownership with longitudinal medical claims data. Their work is set to make a significant contribution to the field, providing the first policy-relevant empirical evidence on the market-wide effects of PE acquisitions.

We spoke to Professor Singh about her upcoming study.

Over the last decade, theres been a rapid increase in institutional investors, such as private equity funds, acquiring physician practices, primarily through consolidation. Private equity aims to generate approximately 20% annual returns over short investment periods of three to seven years. This raises concerns about whether private equitys financial incentives can coexist with physician incentives to deliver affordable, accessible, high-value care for patients.

In the past five years, acquisitions have occurred in several specialties, including dermatology and ophthalmology, and more recently, primary care. A growing body of literature is examining the impact of these acquisitions on health care spending, quality and access outcomes, which is the focus of my research and this grant.

Thats in the ballpark, indicating a rapid trend in corporate consolidation in the last five to ten years. However, specific numbers are hard to confirm due to the private nature of these transactions. Private equity companies are exempt from Securities and Exchange Commission disclosure requirements, and most physician practice acquisitions go unreported to antitrust authorities like the Federal Trade Commission.This lack of transparency is a key policy issue, making it hard for researchers, policymakers, physicians and patients to understand the real magnitude of these trends.

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Spillover effects from private equity acquisitions in the health care sector - Brown University

Seven QHINs will now safely and securely exchange critical health information for patient care

The U.S. Department of Health and Human Services (HHS), through the Office of the National Coordinator for Health Information Technology (ONC), announced today that two additional organizationsCommonWell Health Alliance and Kno2have been designated as Qualified Health Information Networks (QHINs) capable of nationwide health data exchange governed by the Trusted Exchange Framework and Common AgreementSM (TEFCASM). ONC has led a multi-year, public-private process alongside its Recognized Coordinating Entity, The Sequoia Project, Inc., to implement TEFCA, which was envisioned by the 21st Century Cures Act to support nationwide interoperability. TEFCA became operational in December 2023 with the designation of the first five QHINseHealth Exchange, Epic Nexus, Health Gorilla, KONZA, and MedAllies.

CommonWell Health Alliance and Kno2 can immediately begin supporting the exchange of data under the Common Agreement's policies and technical requirements along with the other designated QHINs. QHINs are the pillars of TEFCA network-to-network exchange, providing shared services and governance to securely route queries, responses, and messages across networks for health care stakeholders including patients, providers, hospitals, health systems, payers, and public health agencies.

"These additional QHINs expand TEFCA's reach and provide additional connectivity choices for patients, health care providers, hospitals, public health agencies, health insurers, and other authorized health care professionals," said Micky Tripathi, Ph.D., national coordinator for health information technology. "On behalf of ONC, I want to congratulate CommonWell Health Alliance and Kno2 for their achievement."

"The designation of these two QHINs, which brings the total number of QHINs to seven, highlights the rapid expansion of TEFCA exchange and the support of more and more leaders around TEFCA exchange," said Mariann Yeager, CEO of The Sequoia Project and RCE lead.

Common Agreement Version 2.0, which is anticipated to include enhancements and updates to require support for Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) based transactions, is actively under development and scheduled to be adopted by QHINs within the first quarter of 2024.

Originally posted here:

HHS Expands TEFCA by Adding Two Additional QHINs - HHS.gov

By Darius Tahir February 13, 2024

Lawmakers and regulators in Washington are starting to puzzle over how to regulate artificial intelligence in health care and the AI industry thinks theres a good chance theyll mess it up.

Its an incredibly daunting problem, said Bob Wachter, the chair of the Department of Medicine at the University of California-San Francisco. Theres a risk we come in with guns blazing and overregulate.

Already, AIs impact on health care is widespread. The Food and Drug Administration has approved some 692 AI products. Algorithms are helping to schedule patients, determine staffing levels in emergency rooms, and even transcribe and summarize clinical visits to save physicians time. Theyre starting to help radiologists read MRIs and X-rays. Wachter said he sometimes informally consults a version of GPT-4, a large language model from the company OpenAI, for complex cases.

The scope of AIs impact and the potential for future changes means government is already playing catch-up.

Policymakers are terribly behind the times, Michael Yang, senior managing partner at OMERS Ventures, a venture capital firm, said in an email. Yangs peers have made vast investments in the sector. Rock Health, a venture capital firm, says financiers have put nearly $28 billion into digital health firms specializing in artificial intelligence.

One issue regulators are grappling with, Wachter said, is that, unlike drugs, which will have the same chemistry five years from now as they do today, AI changes over time. But governance is forming, with the White House and multiple health-focused agencies developing rules to ensure transparency and privacy. Congress is also flashing interest. The Senate Finance Committee held a hearing Feb. 8 on AI in health care.

Along with regulation and legislation comes increased lobbying. CNBC counted a 185% surge in the number of organizations disclosing AI lobbying activities in 2023. The trade group TechNet has launched a $25 million initiative, including TV ad buys, to educate viewers on the benefits of artificial intelligence.

It is very hard to know how to smartly regulate AI since we are so early in the invention phase of the technology, Bob Kocher, a partner with venture capital firm Venrock who previously served in the Obama administration, said in an email.

Kocher has spoken to senators about AI regulation. He emphasizes some of the difficulties the health care system will face in adopting the products. Doctors facing malpractice risks might be leery of using technology they dont understand to make clinical decisions.

An analysis of Census Bureau data from January by the consultancy Capital Economics found 6.1% of health care businesses were planning to use AI in the next six months, roughly in the middle of the 14 sectors surveyed.

Like any medical product, AI systems can pose risks to patients, sometimes in a novel way. One example: They may make things up.

Wachter recalled a colleague, as a test, assigning OpenAIs GPT-3 to write a prior authorization letter to an insurer for a purposefully wacky prescription: a blood thinner to treat a patients insomnia.

But the AI wrote a beautiful note, he said. The system so convincingly cited recent literature that Wachters colleague briefly wondered whether shed missed a new line of research. It turned out the chatbot had made it up.

Theres a risk of AI magnifying bias already present in the health care system. Historically, people of color have received less care than white patients. Studies show, for example, that Black patients with fractures are less likely to get pain medication than white ones. This bias might get set in stone when artificial intelligence is trained on that data and subsequently acts.

Research into AI deployed by large insurers has confirmed that has happened. But the problem is more widespread. Wachter said UCSF tested a product to predict no-shows for clinical appointments. Patients who are deemed unlikely to show up for a visit are more likely to be double-booked.

The test showed that people of color were more likely not to show. Whether or not the finding was accurate, the ethical response is to ask, why is that, and is there something you can do, Wachter said.

Hype aside, those risks will likely continue to grab attention over time. AI experts and FDA officials have emphasized the need for transparent algorithms, monitored over the long term by human beings regulators and outside researchers. AI products adapt and change as new data is incorporated. And scientists will develop new products.

Policymakers will need to invest in new systems to track AI over time, said University of Chicago Provost Katherine Baicker, who testified at the Finance Committee hearing. The biggest advance is something we havent thought of yet, she said in an interview.

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'Behind the Times': Washington Tries to Catch Up With AI's Use in Health Care - KFF Health News - Kaiser Health News

One pregnant patient experiencing alarming pain nearly refused to go to an emergency room out of fear that shed be arrested and deported, she said. A staffer at the clinic had to personally escort the patient to the hospital.

There has definitely been an uptick in the nervousness and apprehension that a lot of immigrants already had when they had to think about getting treatment, Thomas said. But I have faith that we will get through this.

DeSantis law is even affecting clinics and organizations that dont receive federal dollars, and the law applies to migrants even though they dont receive Medicaid assistance.

Officials with the Consulate of Mexico in Orlando, which for years has operated a program offering free health care to migrants from all over the world, said fewer migrant women have shown up for free medical check-ups and prenatal care since the law took effect in May. The number of patients accessing free mammograms services, for example, has dropped 18 percent, according to the consulate.

This fear of anything health related has negatively affected the prevention of diseases within our migrant community, the consulate said in a statement.

The consulate does not receive Medicaid reimbursements.

While several states have cracked down on immigration in recent years including a law in Texas that makes it a crime to enter the state illegally from a foreign country Floridas law is believed to be the only one in the nation that requires hospitals to ask patients about their immigration status.

Undocumented immigrants in general arent eligible for federal health benefits, but some states access Medicaid dollars to help undocumented immigrants. Last year, California became the first state in the country to offer health insurance to undocumented immigrants through its Medi-Cal program, which is supported through state and federal taxes..

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'There was a lot of anxiety': Florida's immigration crackdown is causing patients to skip care - POLITICO

Why don't more people want to become mental health care workers in Oregon?  KGW.com

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Why don't more people want to become mental health care workers in Oregon? - KGW.com

Health Care Center residents get chance to holiday 'shop' for loved ones  WBIR.com

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Health Care Center residents get chance to holiday 'shop' for loved ones - WBIR.com

Welp, that didn't take long. The first civil suit against the still-imploding crypto exchange FTX was just filed in a Florida court, accusing FTX, disgraced CEO Sam Bankman-Fried, and 11 of the exchange's many celebrity ambassadors of preying on "unsophisticated" retail investors.

The list of celeb defendants impressive — honestly, it reads more like an invite list to a posh award show than a lawsuit.

Geriatric quarterback Tom Brady and soon-to-be-ex-wife Gisele Bündchen lead the pack, followed by basketball players Steph Curry and Udonis Haslem, as well as the Golden State Warriors franchise; tennis star Naomi Osaka; baseballers Shoehi Ohtani, Udonis Haslem, and David Ortiz; and quarterback Trevor Laurence.

Also named is comedian Larry David — who starred in that FTX Super Bowl commercial that very specifically told investors that even if they didn't understand crypto, they should definitely invest — and investor Kevin O'Leary of "Shark Tank" fame.

"The Deceptive and failed FTX Platform," reads the suit," "was based upon false representations and deceptive conduct."

"Many incriminating FTX emails and texts... evidence how FTX’s fraudulent scheme was designed to take advantage of unsophisticated investors from across the country," it continues. "As a result, American consumers collectively sustained over $11 billion dollars in damages."

Indeed, a number of FTX promos embraced an attitude similar to the cursed Larry David commercial. In one, Steph Curry tells viewers that with FTX, there's no need to be an "expert," while a Naomi Osaka promotion pushed the idea that crypto trading should be "accessible," "easy," and "fun."

It's also worth noting that this isn't the first suit of its kind. Billionaire Mark Cuban, also of "Shark Tank" fame, was named in a class action lawsuit launched against the bankrupt lender Voyager in August, while reality TV star Kim Kardashian was recently made to pay a roughly $1.2 million fine for hawking the "EthereumMAX" token without disclosing that she was paid to do so.

The FTX suit, however, appears to be the most extensive — and high-profile — of its kind. And while a fine for a million or two is basically a one dollar bill to this tax bracket, $11 billion, even if split amongst a group of 11 exorbitantly wealthy celebs, is a more substantial chunk of change.

Of course, whether anyone actually ever has to pay up remains to be seen. Regardless, it's still a terrible look, and real people got hurt. If there's any defense here, though? At least they didn't promise to be experts.

READ MORE: FTX founder Sam Bankman-Fried hit with class-action lawsuit that also names Brady, Bündchen, Shaq, Curry [Fox Business]

More on the FTX crash: Experts Say Sam Bankman-fried's Best Legal Defense Is to Say He's Just Really, Really Stupid

The post Celebrities Are Officially Being Sued by FTX Retail Investors appeared first on Futurism.

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Celebrities Are Officially Being Sued by FTX Retail Investors

Effecting Change

The disgraced former head of the crypto exchange FTX, Sam Bankman-Fried, built his formidable public persona on the idea that he was a new type of ethical crypto exec. In particular, he was a vocal proponent of "effective altruism" — the vague-but-noble concept of using data to make philanthropic giving as targeted and helpful as possible.

But in a direct message, Vox's Kelsey Piper asked Bankman-Fried if the "ethics stuff" had been "mostly a front."

Bankman-Fried's reply: "Yeah."

"I mean that's not *all* of it," he wrote. "But it's a lot."

Truth Be Told

If the concept of becoming rich to save the world strikes you as iffy, you're not alone — and it appears that even Bankman-Fried himself knows it.

When Piper observed that Bankman-Fried had been "really good at talking about ethics" while actually playing a game, he responded that he "had to be" because he'd been engaged in "this dumb game we woke Westerners play where we say all the right shibboleths and everyone likes us."

Next time you're thinking of investing in crypto, maybe it's worth taking a moment to wonder whether the person running the next exchange might secretly be thinking the same thing.

More on effective altruism: Elon Musk Hired A Professional Gambler to Manage His Philanthropic Donations

The post Sam Bankman-Fried Admits the "Ethics Stuff" Was "Mostly a Front" appeared first on Futurism.

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Sam Bankman-Fried Admits the "Ethics Stuff" Was "Mostly a Front"

Italian Import

Carbon dioxide has a bad rep for its role in driving climate change, but in an unexpected twist, it could also play a key role in storing renewable energy.

The world's first CO2 battery, built by Italian startup Energy Dome, promises to store renewables on an industrial scale, which could help green energy rival fossil fuels in terms of cost and practicality.

After successfully testing the battery at a small scale plant in Sardinia, the company is now bringing its technology to the United States.

"The US market is a primary market for Energy Dome and we are working to become a market leader in the US," an Energy Dome spokesperson told Electrek. "The huge demand of [long duration energy storage] and incentive mechanisms like the Inflation Reduction Act will be key drivers for the industry in the short term."

Storage Solution

As renewables like wind and solar grow, one of the biggest infrastructural obstacles is the storage of the power they produce. Since wind and solar sources aren't always going to be available, engineers need a way to save excess power for days when it's less sunny and windy out, or when there's simply more demand.

One obvious solution is to use conventional battery technology like lithium batteries, to store the energy. The problem is that building giant batteries from rare earth minerals — which can be prone to degradation over time — is expensive, not to mention wasteful.

Energy Dome's CO2 batteries, on the other hand, use mostly "readily available materials" like steel, water, and of course CO2.

In Charge

As its name suggests, the battery works by taking CO2, stored in a giant dome, and compressing it into a liquid by using the excess energy generated from a renewable source. That process generates heat, which is stored alongside the now liquefied CO2, "charging" the battery.

To discharge power, the stored heat is used to vaporize the liquid CO2 back into a gas, powering a turbine that feeds back into the power grid. Crucially, the whole process is self-contained, so no CO2 leaks back into the atmosphere.

The battery could be a game-changer for renewables. As of now, Energy Dome plans to build batteries that can store up to 200 MWh of energy. But we'll have to see how it performs as it gains traction.

More on batteries: Scientists Propose Turning Skyscrapers Into Massive Gravity Batteries

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Startup Says It's Building a Giant CO2 Battery in the United States

Elon Musk's Twitter operations are still in free fall.

Earlier this week, the billionaire CEO sent an email to staff telling them that they "need to be extremely hardcore" and work long hours at the office, or quit and get three months severance, as The Washington Post reports.

Employees had until 5 pm on Thursday to click "yes" and be part of Twitter moving forward or take the money and part ways. The problem for Musk? According to former Uber engineer Gergely Orosz, who has had a close ear to Twitter's recent inner turmoil, "far fewer than expected [developers] hit 'yes.'"

So many employees called Musk's bluff, Orosz says, that Musk is now "having meetings with top engineers to convince them to stay," in an  embarrassing reversal of his public-facing bravado earlier this week.

Twitter has already been rocked by mass layoffs, cutting the workforce roughly in half. Instead of notifying them, employees had access to their email and work computers revoked without notice.

Even that process was bungled, too, with some employees immediately being asked to return to the company after Musk's crew realized it had sacked people it needed.

According to Orosz's estimations, Twitter's engineering workforce may have been cut by a whopping 90 percent in just three weeks.

Musk has been banging the war drums in an active attempt to weed out those who aren't willing to abide by his strict rules and those who were willing to stand up to him.

But developers aren't exactly embracing that kind of tyranny.

"Sounds like playing hardball does not work," Orosz said. "Of course it doesn't."

"From my larger group of 50 people, 10 are staying, 40 are taking the severance," one source reportedly told Orosz. "Elon set up meetings with a few who plan to quit."

In short, developers are running for the hills — and besides, they're likely to find far better work conditions pretty much anywhere else.

"I am not sure Elon realizes that, unlike rocket scientists, who have relatively few options to work at, [developers] with the experience of building Twitter only have better options than the conditions he outlines," Orosz argued.

Then there's the fact that Musk has publicly lashed out at engineers, mocking them and implying that they were leading him on.

Those who spoke out against him were summarily fired.

That kind of hostility in leadership — Musk has shown an astonishing lack of respect — clearly isn't sitting well with many developers, who have taken up his to get three months of severance and leave.

"I meant it when I called Elon's latest ultimatum the first truly positive thing about this Twitter saga," Orosz wrote. "Because finally, everyone who had enough of the BS and is not on a visa could finally quit."

More on Twitter: Sad Elon Musk Says He's Overwhelmed In Strange Interview After the Power Went Out

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Panicked Elon Musk Reportedly Begging Engineers Not to Leave