Oct 1st 2020

A SOLDIER WATCHES a car approaching a check-point on a hot, dusty road. As the vehicle slows to a stop in front of him, he asks the driver to get out and show his identification. Seconds later, the rattle of gunfire pierces the air, followed by a bang and an intense, searing flash. Knocked to the ground and scrambling to safety, the soldier turns to see a flaming wreck where the car had been just moments before.

The scene pauses. A voice in the soldiers ear says: Lets rewind the simulation to the seconds just before the explosiondescribe exactly what happened. The voice is a therapist, speaking to a veteran who is placed in a virtual environment. The simulation they are watching has been modelled on the veterans own experiences in a war zone, events that have led him to develop post-traumatic stress disorder (PTSD).

This is the Bravemind system, developed in 2005 by Albert Skip Rizzo and Arno Hartholt, experts in medical virtual reality at the University of Southern California, to treat soldiers returning home from the wars in Iraq and Afghanistan. Immersed in a virtual environment that mimics their traumatic experiences, veterans narrate the scene to a therapist, who can control how the events in the simulation unfold. The sounds, time of day and number of people or vehicles on the scene can all be customised. Over several sessions, the veteran is exposed to increasingly intense scenarios that get closer to reliving the memory of the original trauma. The aim of the therapy is to steadily dampen the veterans negative reactions to the memory. Bravemind is now used in around 60 treatment centres around the world.

Bravemind builds on a well-established psychological technique known as exposure therapy, in which people are brought to face their fears in a controlled way. VR adds a way of creating detailed, carefully tuned scenarios that can elicit different levels of fear. It works because, even when people know they are watching computer graphics, their brains nonetheless react to virtual environments as if they were real.

Someone who is afraid of heights will find that their heartbeat quickens and palms get clammy even if the precipitous drop they can see is clearly a computer graphic in a VR headset. This is because the brains limbic system, which controls the fight-or-flight response, activates within milliseconds in response to potential threats, long before the logical part of the brainwhich knows the VR experience is not physically realcan intervene.

Scientists have used VR systems to create and control complex, multi-sensory, 3D worlds for volunteers in their labs since the 1990s. Rather as an aircraft simulator can train and test pilots in a wide variety of settings, virtual worlds allow psychologists and neuroscientists to watch peoples cognitive and emotional responses in situations that are difficult to set up or control in the real world. But the technology has usually been too clunky and expensive for widespread clinical use.

That has started to change, thanks to the falling costs of computing and the increasing capability of the new generation of VR systems. At the same time, the scientific evidence base for the clinical uses of VR has grown. The technology has been successfully applied to tackling schizophrenia, depression and phobias (including the fear of flight, arachnophobia, social anxiety and claustrophobia), and reducing pain in cancer patients undergoing chemotherapy. It can help train spatial-navigation skills in children and adults with motor impairments and assist in rehabilitation after a stroke or traumatic brain injury. The kit can also be used to monitor people and identify medical problems: VR has been used to diagnose attention-deficit hyperactivity disorder (ADHD) and Parkinsons and Alzheimers diseases.

Though each condition is unique, researchers have found common ground rules for designing virtual experiences that work: therapists need to be in control of the scene, deciding what a patient sees and hears in order to modify the strength of the fearful stimulus; the therapy works best when the patient is embodied within an avatar, rather than floating, so that they feel present within the scene; and the patient needs agency, so that they can leave the scene if it gets too overwhelming for them. All this adds up to giving the patient the illusion of control and makes the VR experience feel psychologically real.

In some cases the therapeutic regime is so robust that, instead of a real-life therapist guiding a patient through an anxiety-inducing simulation, an animated avatar can do the job instead. A clinical trial showed that such an automated system, designed by Daniel Freeman, a psychiatrist at the University of Oxford, helped people reduce their fear of heights. In the simulation, a virtual counsellor guided patients up a virtual ten-storey office complex, where the upper floors overlooked a central atrium. At each floor, the counsellor set the patient tasks designed to test and help them manage their fear responses, such as walking to the edge of a balcony while the safety barrier was lowered or riding on a moving platform over the space above the atrium.

Dr Freeman found that six sessions of virtual, automated therapy over two weeks significantly reduced peoples fear of heights, compared with people who had no therapy. A similar automated virtual therapy for arachnophobia, developed by Philip Lindner at Stockholm University, helped patients eventually touch spiders. The reduction in fear was still apparent when the participants were followed up a year later.

For doctors, virtual environments also provide a risk-free way to practise important procedures. Surgeons operate in high-pressure environments with a lot of cognitive demands. Youve got to learn very rapidly, and youve got to make decisions under time pressure, with millimetre precision, says Faisal Mushtaq, a cognitive neuroscientist at the University of Leeds in England.

Practising with computer simulations can help. In the NeuroVR system, developed by a group of Canadian hospitals and universities, surgeons can use MRI scans from their patients to rehearse removing brain tumours before going in with the knife for real. The surgeon gets a 3D view of the tumour on screens and practises cuts and movements by manipulating instruments attached to a robotic arm that responds with haptic feedback. This allows users to sense whether they are cutting through hard or soft material, or through a tumour versus healthy tissue. An advantage of such a system is that, once a doctor is trained, the technology can be used to perform remote surgery. Both virtual training and remote procedures for patients are useful at a time when covid-19 has forced health-care systems around the world to keep doctors and non-emergency patients apart.

When surgeons try to reconstruct a limb, a key problem is identifying important blood vessels that need to be protected during the surgery. In the past a surgeon would try to identify those vessels using an ultrasound probe, but the process is lengthy and imprecise. So James Kinross, a consultant surgeon at Imperial College London, has been experimenting with Microsofts HoloLens, an augmented-reality headset, which can overlay computer-generated text and images onto the real world.

Dr Kinross has used a CT scan of a patients limb to highlight the most important blood vessels. He reconstructed that scan as a 3D model in Unity, a games engine. The HoloLens then overlaid that simulation onto the patients real limb in the operating theatre during treatment. What it meant was that the surgeon could immediately visualize, and very precisely map, the anatomy of these blood vessels, and very quickly identify them and protect them, says Dr Kinross, who has also used this technique during cancer surgery to help surgeons identify and protect healthy tissue. The adoption of the technology has proceeded very smoothly, he adds, because it is easy to learn and provides an immediate and very obvious advantage to the clinician.

He thinks the technology could be pushed much further and wants to try some real-time collaboration with his colleagues during a surgical procedure. So if youre running an operation thats challenging, or you want to have a discussion with a peer, its very easy to do and they can have a first-person view of what youre looking at, he says.

Medical uses for computer simulations are promising, but how useful they are will take time to evaluate. That will require robust clinical trials and discussions of frameworks for data protection on technologies that could, if their potential is achieved, become a new type of medical device.

We dont want to poison the well, says Dr Mushtaq. We dont want to put out systems that are ineffective, that are going to cost our health-care system, and that are going to negatively impact on the growth of this sector. His research focuses on closing some of those knowledge gaps by examining how the lessons users learn from practising on virtual simulators translate into skills in the real world. Surprisingly, the fidelity of the images to real surgery is not so important. Something can look very, very, flashyits got all the blood spewing everywhere and so on, he says. But it doesnt necessarily translate to better learning.

Defining the validity of a simulator can take several forms. The most basic is face validity, which reflects how well a simulation looks like the task in the real world. Construct validity is a way of comparing performance differences on the simulation between experts and novices. Finally, predictive validity is most useful, because it measures how well a persons performance on a simulator predicts their ability to do the same task in the real world.

This can also be used to flag when learners are struggling, and provide early intervention and support. Dr Mushtaq and his colleagues have demonstrated both construct and predictive validity for the Nissin (formerly Moog) Simodont dental-surgery simulator, used by the University of Leeds to train its students. In research published in 2019, they found that scores on the simulator predicted someones performance in a clinic two years later.

Video-game engines have made face validity easier to achieve for simulators. The next step is to measure construct and predictive validity more robustly. Unfortunately, precious little of this kind of validation work is undertaken by academics or companies selling simulators. To help grease the wheels and encourage researchers to build a body of knowledge, Dr Mushtaq and his colleagues recently created a set of tools and protocols that streamline human-behaviour research and make use of the Unity game engine as a platform. This Unity Experiment Framework takes care of the tedious programming stepsdownloading files that track all of a users movements, for example, or anonymising participantsneeded to turn the game engine into an environment optimised for studying people.

Mark Mon-Williams, a cognitive psychologist at the University of Leeds who has worked with VR for more than two decades, reckons simulated worlds have huge potential for improving education and physical and mental health. But if youre going to make the most of that powerful set of tools, he says, then use the scientific process to ensure that its done properly.

This article appeared in the Technology Quarterly section of the print edition under the headline "Getting better"

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Health care is already benefiting from VR - The Economist

Which Country Has the Worlds Best Health Care?

by Ezekiel J. Emanuel

PublicAffairs, 453 pp., $30.00

Bow your heads, folks, conservatism has hit America, The New Republic lamented following the 1946 elections. All the rest of the world is moving Left, America is moving Right. Having dominated both houses of Congress throughout President Franklin Roosevelts three-plus terms in office (19331945), Democrats lost their majorities in a blowout. Some blamed it on the death of FDR, others on the emerging Soviet threat or the bumpy return to civilian life following World War II. The incoming Republican Class of 46 would leave a deep mark on history; its members, including Californias Richard Nixon and Wisconsins Joseph McCarthy, were determined to root out Reds in government and rein in the social programs of the New Deal.

One issue in particular became fodder for the Republican assault. In 1945 President Harry Truman had delivered a special message to Congress laying out a plan for national health insurancean idea the pragmatic and immensely popular FDR had carefully skirted. As an artillery officer in World War I, Truman had been troubled by the poor health of his recruits, and as chairman of a select Senate committee to investigate the defense program during World War II, his worries had grown. More than five million draftees had been rejected as unfit for military service, not counting the 1.5 million discharged for medical reasons following their induction. For Truman, these numbers went beyond military preparedness; they spoke to the glaring inequities of American life. People with low or moderate incomes do not get the same medical attention as those with high incomes, he said. The poor have more sickness, but they get less medical care.

Truman proposed federal grants for hospital construction and medical research. He insisted, controversially, not only that the nation had too few doctors, but that the ones it did have were clustered in the wrong places. And he addressed the principal reason that forced so many Americans to forgo vital medical care: They cannot afford to pay for it.

The facts seemed to bear him out. Close to half the counties in the United States lacked a general hospital. Government estimates showed that about $11 million was spent annually on new treatments and cures for disease, as opposed to $275 million for industrial research. Though the nation claimed to have approximately one physician per 1,500 people, the ratio in poor and rural counties regularly dipped below one per 3,000, the so-called danger line. On average, studies showed, two thirds of the population lacked the means to meet a sustained health crisis.

The concept of government health insurance was not entirely new. A few states had toyed with instituting it, but their intent was to replace wages lost to illness or injury, not to pay the cost of medical care. Trumans plan called for universal health insuranceunlike the Social Security Act of 1935, which excluded more than 40 percent of the nations labor force, mostly agricultural and domestic workers. Funded by a federal payroll tax, the plan offered full medical and dental coverageoffice visits, hospitalization, tests, procedures, drugsto all wage and salary earners and their dependents. (Needy persons and other groups were promised equal coverage paid for them by public agencies.)

People would be free to choose their own doctors, who in turn could participate fully, partly, or not at all in the plan. Private health insurance programs would continue to operate, with policyholders required to contribute to the federal system as wella stipulation the president compared to a taxpayer choosing to send a child to private school. What I am recommending is not socialized medicine, Truman insisted. Socialized medicine means that all doctors work as employees of government. The American people want no such system. No such system is here proposed.

It did him no good. At the first Senate hearing on the proposal, Ohios Robert A. Taft, a perennial presidential candidate known to his admirers as Mr. Republican, denounced it as the most socialistic measure that this Congress has ever had before it. A shouting match ensued, with one Democrat warning Taft to shut your mouth up and get out of here. Taft retreated, but not before vowing to kill any part of the plan that reached the Senate floor.

Taft was not without allies. A predictable coalition soon emerged, backed by pharmaceutical and insurance companies but directed by the American Medical Association, which levied a $25 political assessment on its members to finance the effort. At its crudest, the campaign pushed a kind of medical McCarthyism by accusing the White House of inventing ways to turn a brave, risk-taking people into a bunch of dainty, steam-heated, rubber-tired, beauty-rested, effeminized, pampered sissieseasy pickings for the nations godless cold war foe. UNAMERICAN SYSTEM BLUEPRINTED IN THE KREMLIN HEADQUARTERS OF THE COMMUNIST INTERNATIONALE, read one AMA missive describing the origins of Trumans plan.

Precious freedoms were at stake, Americans were told: when the president claimed that medical choices would remain in private hands, he was lying; federal health insurance meant government control; decisions once made by doctors and patients would become the province of faceless bureaucrats; quality would suffer and privacy would vanish. Skeptics were reminded of Lenins alleged remarklikely invented by an opponent of Trumans heath planthat socialized medicine represented the keystone to the arch of the socialized state.

The economist Milton Friedman once described the AMA as perhaps the strongest trade union in the United States. It influenced medical school curriculums, limited the number of graduates, and policed the rules for certification and practice. For the AMA, Trumans proposal not only challenged the professions autonomy, it also made doctors look as if they could not be trusted to place the countrys needs above their own. As a result, the AMA ran a simultaneous campaign congratulating its members for making Americans the healthiest people in the world. The existing system worked, it claimed, because so many physicians followed the golden rule, charging patients on a sliding scale that turned almost no one away. If the patient was wealthy, the fee went up; others paid less, or nothing at all. What was better in a free society: the intrusive reach of the state or the big-hearted efforts of the medical community?

Given the stakes, the smearing of national health insurance was not unexpected. What did come as a surprise, however, was the palpable lack of support for the idea. For many Americans, the return to prosperity following World War II made Trumans proposal seem less urgent than the sweeping initiatives that had ended the bread lines and joblessness of the Great Depression. Even the Democratic Partys prime constituencyorganized laborshowed limited interest. During the war, to compensate workers for the income lost to wage controls, Congress had passed a law that exempted health care benefits from federal taxation. Designed as a temporary measure, it proved so popular that it became a permanent part of the tax code.

Unions loved the idea of companies providing health insurance in lieu of taxable wages. It appeared to offer the average American the sort of write-off reserved for the privileged classes, and indeed it did. Current studies show that union members are far more likely to have health insurance and paid sick leave than nonunion workers in the same industry. Employer-sponsored health insurance now amounts to the nations largest single tax exemption, costing the government more than $250 billion annually in lost revenue.

At about the same time, popular insurance plans like Blue Cross emerged to offer cheap, prepaid hospital care, followed by Blue Shield for doctors visits. In 1939 fewer than six million people carried such insurance; by 1950, that number had increased fivefold. In the years after Trumans plan died in Congress, the government filled some of the egregious gaps in the private insurance system with expensive programs for the poor, the elderly, and others in high-risk categories, thereby cementing Americas outlier status as the worlds only advanced industrial nation without universal health care.

What the United States does have in common with several of these nations, says Ezekiel Emanuel in his valuable Which Country Has the Worlds Best Health Care?, is that its health care struggles have not been unlike theirs, despite the markedly different outcomes. The United Kingdom, for example, decided in favor of national health care at the very moment that Trumans plan was being shredded. And the main adversary turned out to be the British Medical Association, which used the hated specter of Nazism (as opposed to Bolshevism) to demonize the proposed National Health Service as a Hitlerian menace run by a medical fuhrer.

The NHS succeeded because the Labour Party won a landslide victory in 1945 in a country battered by war and facing a bleak economic futureprecisely the opposite of the American experience. Opinion polls in the UK showed strong support for a government-run system offering universal, comprehensive, and free health care financed by general taxation. But the threat of a physicians strike forced Labours health minister, Aneurin Bevan, to scrap the idea of turning doctors into full-time government employees. Senior specialists (or consultants) would be allowed to see private patients beyond their salaried employment in Britains government-run hospitals, and general practitioners could retain their status as independent contractors, though they would get virtually all their income through the NHS. Generous pensions and other benefits sweetened the deal. I stuffed their mouths with gold, Bevan recalled.

The UK and the US are the bookends of the eleven health care systems that Emanuel has studiednot so much to determine which one is best or worst, as which one most closely resembles a socialized system. (The others are Australia, Canada, China, France, Germany, the Netherlands, Norway, Switzerland, and Taiwan.) The UK excels in universal coverage, simplicity of payment, and protection of low-income groups. While the NHS remains quite popular, it also is seriously underfunded: the UK ranks dead last in both health care spending per capita ($3,900) and health care spending as a percentage of gross domestic product (9.6) among the six European nations under examination. The most common complaints, not surprisingly, concern staff shortages and wait times for primary care appointments, elective surgeries, and even cancer treatments, which can stretch for months. The public does not want to replace the system with an alternative, writes Emanuel. All the public wants is a fully operational NHS.

By contrast, the US health care systemif one can call it thatexcludes more people, provides thinner coverage, and is far less affordable. It combines socialized medicine practiced by the Department of Veterans Affairs, four-part federal Medicare (A, B, C, D) for the elderly and disabled, state-by-state Medicaid for the poor, health coverage provided by employers, and policies bought privately through an insurance agent or an Affordable Care Act exchangeall of which still leave 10 percent of the population unprotected. Among the biggest problems, says Emanuel, is that Americans are baffled by their health care: uncertain of the benefits theyre entitled to, the providers that will accept their insurance, the amount of their deductibles and copays, and the accuracy of the bills they receive. It is a system, moreover, in which people are regularly switching insurers out of choice or necessitya process known as churning. The United States basically has every type of health financing ever invented, Ezekiel adds. This is preposterous.

And extremely expensive. America dwarfs other nations in both health care spending per capita ($10,700) and health care spending as a percentage of GDP (17.9). Hospital stays, doctor services, prescription drugs, medical devices, laboratory testingthe excesses are legion. Childbirth costs on average about $4,000 in Western Europe, where midwives are used extensively and charges are bundled together, but close to $30,000 in the US, where the patient is billed separately by specialistsradiologists, pathologists, anesthesiologistswhom she likely never meets, and where charges pile up item by item in what one recent study called a wasteful overuse of drugs and technologies. There is no evidence that such extravagance makes for better health care outcomes. The rates of maternal and infant death in the US are higher than in other industrialized nations, partly because the poor, minorities, and children are disproportionately uninsured.

For head-spinning price disparities, however, nothing compares to pharmaceuticals. Americans account for almost half the $1 trillion spent annually for prescription drugs worldwide, while comprising less than 5 percent of the worlds population. It is probably no coincidence that the pharmaceutical industry spent almost twice as much on political lobbying between 1998 and 2020 as its nearest competitor, the insurance industry. (The hospital/nursing home industry came in eighth.) Drug companies won patent protection, restraint-free pricing, and direct-to-consumer advertising (outside the US, only New Zealand allows this). This high spending for drugs, writes Emanuel, with some understatement, is a result of high drug prices, not high drug use by Americans.

How do other countries keep drug costs down? By using the full power of government (or a surrogate) to negotiate lower prices, as opposed to the market fragmentation that diminishes consumer leverage in the United States. Some governments shop for pharmaceuticals, paying no more than the lowest prices charged by other developed nations. And some use an internal metric that pegs prices to what that country already pays for drugs in the same class. Canada, which employs both methods, has become a haven for consumers south of the border, even though the importation of prescription drugs into the United States is generally illegal. Emanuel favors no single approach; he is open to almost anything that avoids the highway robbery Americans wearily tolerate. I am agnostic about how best to regulate drug prices, he admits, but having some objective and rigorous system for setting prices is definitely better than leaving it to drug companies with monopoly pricing power.

Emanuel is a man of many lists. I rank everything, he writes:

I rank the 10 best meals Ive ever had (#1 Alinea in Chicago). I rank chocolates (#1 Askinosie). I rank Alpine cheeses (#1 is a tie between Alpha Tolman and Alp Blossom). I rank colleges. I rank academic departments of bioethics and health policy that compete with my own. I rank the meals I cook, the races I run, the bike rides I take, the speeches I give.

A bit obsessive, no doubt, though its hard to imagine anyone better suited to rank the worlds health care systems than an oncologist with a Harvard medical degree and a Harvard Ph.D. in political philosophy who was deeply involved in crafting the Affordable Care Act and currently chairs the Department of Medical Ethics and Health Policy at the University of Pennsylvania. Emanuel likes controversy and the limelight that comes with it. Several years ago, he wrote an essay for The Atlantic insisting that he had no interest in living past seventy-five, the approximate age, he said, at which people appear more burdensome than productive. Rather than killing himself, Emanuel vowed to refuse all measures to prolong his life, from cancer screenings to antibiotics to the flu shot. (Those who skimmed the lengthy piece may have overlooked the disclaimer I retain the right to change my mind carefully tucked into the final paragraph.) Few people took him seriously, I suspect, beyond the likes of Newt Gingrich and Sarah Palin, who had previously (and falsely) accused Emanuel of wanting to create death panels to deny treatment to the elderly and disabled.

Ranking the worlds health care is something of a cottage industry. The gold standard, until now, has been the Commonwealth Fund, which publishes periodic assessments comparing the US system to those of ten other countries, much as Emanuel has done. The 2017 Commonwealth study includes two nations (Sweden and New Zealand) not on Emanuels list; his study includes two nations (Taiwan and China) not on the Commonwealth list. Both employ similarly broad categories such as access, equity, coverage, efficiency, financing, and delivery. The Commonwealth studies rely heavily on surveys of patients and primary care doctors, as well as comparative data drawn from sources like the World Health Organization. Emanuel takes a more qualitative approach, providing histories of each nation that elegantly describe the impact of politics and culture on current policy. He also is more hesitant to rely on data that are not easily compared among nations with different approaches to managed care. Such numbers, he writes, must be taken with heaping grains of salt.

So who are the winners and losers? The 2017 Commonwealth study ranks the UK first, followed closely by Australia and the Netherlands. In last place, hands down, is the United States, which fails in almost every category. Emanuel ranks the United States next to lastbut only because his study includes China. While acknowledging dramatic progress made there in health care outcomes such as infant mortality and life expectancy, Emanuel has little good news to report about China beyond the hope that its rapidly growing middle class will soon be demanding better medical care.

And first place? The answer isblank. There are too many variables and too few precise measurements to pick an overall winner, Emanuel confesses to the reader on page 351. The best that he can do is to lump the eleven nations into tiers, with Germany, the Netherlands, Norway, and Taiwan at the top. Which ranks highest depends on your priorities. If your main ones are the choice of doctor and hospital, short waiting times, and good long-term care, you probably will pick Germany. If youre focused on rock-bottom prescription drug prices and an outstanding electronic records system, Taiwan is the place. If you worry about copayments and deductibles, England and Canada await. Finding the best heath care, it appears, is harder than finding the best Alpine cheese.

Shortly after this book was published, Emanuel was interviewed on a podcast with a very insistent host. Asked point-blank which nation had the best health care, he first refused to say. I was ready for your evasive answer, the host responded. Which system would you want to buy into? Cornered, Emanuel chose the Netherlands. I think that they have a very good combination, he declared:

You get to choose your private insurer, you get to choose your primary care doctor. And their primary care doctors are really gatekeepers to a higher level of care. Theyre also innovative. But there are lots of other alternatives Id be more than happy with.

This is hardly a revelation. The Dutch have long been content with their system. It doesnt lead in any of the main categories, but it does everything well. Where Emanuel and fellow rankers part ways is in their vision of the future. Emanuel is bullish on America. He sees it emerging as a world health care leader, despite its dismal current standing and the politically charged opposition of most Republicans to meaningful change. The United States does excel on some dimensions, particularly innovation and experimentation in payment models and care delivery, he writes. Im optimistic about [its] long-term performance. Time will tell.

The first order of business, Emanuel believes, is universal coverage. No system that shuts out so many people can claim to be just or effective. Other industrialized nations have achieved universal coverage through automatic enrollment, and Emanuel thinks it could work here by funneling people into Medicaid or one of the lower-cost insurance exchanges. The process will entail larger government subsidies for the uninsured and underinsured, including middle-class families, but it will also ease the rampant confusion that keeps millions of Americans from claiming the benefits they already are entitled to. Emanuel sees automatic enrollment as both essential and nonthreateninga social good requiring little systemic change.

More controversial is his recommendation aimed at bringing some order to the current system. He likes the idea of having everyone covered by one of two options: either employer-sponsored insurance or a government-sponsored alternative that combines Medicare, Medicaid, and the Obamacare exchanges into a coherent entity. At the very least, it would be simpler to navigate, streamline medical billing, reduce the administrative quagmire faced by providers, and supply some added leverage against monopolistic price-gouging. Studies estimate that the United States spends a staggering $500 billion annually on billing and insurance-related costs, with $240 billion classified as excessor waste. The average US physician practice spends four times as much on billing as its Canadian counterpart.

It is hard to imagine that anyone intended to design a system this dysfunctional. The good news, says Emanuel, is that underperformance of such magnitude inevitably spurs innovation. The surge in costs has generated new interest in payment models that have worked elsewhere, such as capitation, which pays the physician a fixed fee for a patients care over a specified period of time, and bundling, which puts multiple health care services under a single billing code. America is becoming a leader in coordinating the care of patients with chronic physical and mental conditionsinnovations Emanuel clearly lays out here. Even the systems once-static care delivery system has been invigorated by additions like the physicians assistant, who is licensed to treat illness and prescribe medication, and the virtual office visit that has become so essential during the current pandemic.

Covid-19 arrived just as Emanuels book was heading to the printer. Not surprisingly, his editor asked him to compose an addendum suggesting what the coronavirus might tell us about the nations health care system. Written obviously in haste, it still covers the bases rather well. The absence of universal coverage, combined with high deductibles and copays, made it less likely for people with symptoms to seek medical help, thus endangering them and the rest of us. Americas hospitals and health care facilities now face a sea of red ink, with losses estimated in the hundreds of billions of dollars. Elective surgeries, a primary revenue stream, have slowed to a trickle, while prices for drugs and protective equipment have steadily mounted. It is too early, of course, to attempt a serious ranking of the effectiveness of countries responses to Covid-19. That surely will come, with perhaps predictable results. What can be noted at this point is the exemplary performance of the nations front-line health workers and first responders.

There are signs that the pandemic has had an effect on public attitudes. Since June, voters in deep red Oklahoma and Missouri have defied their political leaders by supporting constitutional amendments that require the expansion of eligibility for Medicaid, one of the provisions of Obamacare that many Republican-controlled state governments have refused to implement. South Dakota may follow suit in 2022. The AMA has also evolved over the years: its current vision on health care reform now calls for freedom of choice, freedom of practice, and universal access for patients, which is another way of saying that it endorses the expansion of the Affordable Care Act for those without insurance while still opposing a single-payer national health plan. This alone is progressseventy-five years after President Trumans clarion call for health care justice.

Continued here:

Health Care: The Best and the Rest | by David Oshinsky - The New York Review of Books

Since 1968, National Hispanic Heritage Month has been recognized by the federal government and celebrated across the United States annually, from Sept. 15 to Oct. 15 to acknowledge the history, culture, and contributions of Americans whose ancestry can be traced to over 20 countries in Latin America, including Mexico, Central and South America, and the Caribbean. There are approximately 60 million people residing in the U.S. representing approximately 18% of the population, who have ancestries connected to these countries.

The University of Nevada, Reno School of Medicine (UNR Med) and University Health join in celebrating this annual commemoration as part of our commitment to diversity and inclusion and our ongoing efforts to increase the representation of Hispanics, and others from populations underrepresented in medicine, who serve our community as healthcare providers.

Diversity in health care benefits students and their future patients.

Diversity enhances the learning experience of all students through broadened perspectives, intellectual engagement, social skills, empathy, and racial understanding all critical components of medical education for future physicians. Ultimately, diversity helps equip future physicians to combat health care disparities, which will positively impact health care outcomes for their patients.

The future of medicine doesnt just lie in technological advancements or scientific discoveries, says first-year medical student, Leanne Perez. The future of medicine is about diversity, and reflecting a new, dynamic generation of doctors who represent every and any patient.

UNR Med is making great strides in training a broader spectrum of future physicians, capable of relating to patients and speaking their language, both literally and figuratively.

For second-year UNR Med medical student Sergio Trejo, being Hispanic and a Spanish speaker has been an enormous asset in understanding cultural subtleties and prominent social health determinants. I volunteer as an interpreter and student provider for clinics that serve underserved communities and interact with English language-challenged patients in navigating the health care field. When patients are able to precisely describe what brings them into the clinic in their own language with a health care professional who understands them, theyre overcome with a sense of relief and gratefulness. This is my motivation for dedicating my career to serving underserved populations, especially those who face massive language barriers.

Diversity in health care advances academic excellence.

The Association of American Medical Colleges (AAMC) reports that Hispanic matriculation to U.S. medical schools was 6.2% for the 2018-19 academic year. At UNR Med, the number of enrolled Hispanic medical students has more than doubled since 2011, reaching 20% for the 2020-21 academic year. In addition, more than half of the UNR Med Class of 2024 medical students represent UNR Med Mission-Based Diversity Groups, reflecting Nevadas diverse population. During this same period of time, the size of our application pool continued to grow and the average academic credentials of incoming students remained consistent or improved.

Commitment to diversity starts with engaging in outreach that exposes young people from groups underrepresented in medicine to role models and that inspires them to pursue a career in healthcare, said Tamara Martinez-Anderson, director of admissions. It is also reflected in a holistic admissions process that requires academic and professional readiness for medical school, but also considers how each candidates diverse competencies, attributes and backgrounds align with our mission and values. We know that achieving our vision of a healthy Nevada benefits when we enroll future doctors who are collaborative, resilient and adaptable and who are committed to providing compassionate, sensitive and culturally competent care.

UNR Meds total enrollment of Hispanic students is around 54 students, including the School of Medicine, Physician Assistant Studies Program and Speech Pathology and Audiology student bodies. Over the past four years, UNR Med has nearly tripled Latinx and Black faculty representation.

Diversity in health care starts long before medical school.

Pre-med pipeline programs and initiatives have been shown to help underrepresented students better prepare for the medical school admissions process. Developing and expanding these avenues of educational support continue to be a strong priority for UNR Meds Office of Admissions.

The mission of the Community of Bilingual English-Spanish Speaker Exploring Issues in Science and Health (CBESS) program is to create opportunities to position bilingual high school students as insiders into STEM-healthcare fields. CBESS aims to increase diversity in the health care workforce by providing programming for Spanish-English bilingual high school juniors through networking events with health care professionals, medical school tours, and a variety of other activities. The initiative is collaboration between the Universitys College of Education, Raggio Research Center, School of Community Health Sciences and School of Medicine.

Sergio Trejo became involved with CBESS, and his experience as a student in the program led him to choose UNR Med for medical school. Ive always been interested serving underserved communities, especially those who face prominent language barriers. I decided to attend UNR Med because Tamara Martinez-Anderson and other faculty demonstrated how UNR Med has similar goals in striving to alleviate health disparities for Nevada's underserved populations and beyond.

In support of first-generation and low-income undergraduate students who are preparing for the medical school application process, the Office of Admissions has partnered with the University of Nevada, Reno TRiO Scholars Program to offer pre-med advising and learning support. Also available is a one-year Post-Baccalaureate Certificate that provides a small and select group of students, frequently from non-traditional or underrepresented backgrounds, with the opportunity to demonstrate their academic readiness in a pipeline program that mimics the intensity of medical school.

Another pipeline program involves early interventions to make reaching the goal of medical school more sustainable over the long term. The BS-MD Program grants exceptional high school students conditional direct-entry admission to UNR Med upon completion of all requirements of a structured, four-year undergraduate pre-med program at the University of Nevada, Reno.

As a first-generation medical student, Leanne Perezs dream of becoming a physician felt discouraging at first, so the BS-MD program was key to guiding her throughout her undergraduate degree all the way to medical school. I am honored to represent the Hispanic community, as it is so important for minority populations to identify with their physicians. Coming from an underrepresented community, I am so proud to attend a medical school that prioritizes diversity and outreach.

Our commitment to diversity is a pledge to seeing that all members of our community are able to access the quality health care they need, said UNR Med Dean, Thomas L. Schwenk, M.D. In northern Nevada, we not only have great health care infrastructure but a School of Medicine that is actively partnering with our health care community to build relationships and increase access to, and equity in health care for all.

UNR Meds success in recruiting, enrolling and graduating increasing Hispanic medical students is reflective of the broader University of Nevada, Reno goal to become a Hispanic-Serving Institution, with Hispanic students making up at least 25% of the undergraduate, full-time student population.

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Diversity in health care starts at the beginning - Nevada Today

Special to the Bulletin

WednesdayOct7,2020at4:42PM

Respiratory therapists and the work they do will be observed during Respiratory Therapist Week later this month, Oct. 25-31.

Respiratory therapy (RT) is part of the critical care team in a hospital, from newborns to elderly. RT also has hands-on care for COVID 19 patients.

RT is usually thought of as the people who give breathing treatments. However, it goes a lot further than that. RT is part of a core and experienced team who responds to all respiratory and cardiac arrests.

RTs education certainly focuses on the heart and lungs, but RT professionals learn so much more. From simple lab values, chest X-rays, CT scans to hemodynamics, RT manages ventilators from neonates to geriatrics.

All of the RT professionals at Brownwood Regional Medical Center are required to have special certifications including ACLS (advanced cardiac life support), PALS (pediatric advanced life support, and NRP (neonatal resuscitation program).

There is much more RT could tell the public. Brownwood Regional Medical Center has an amazing RT team with more than 115 years combined experience.

The medical diretor is Dr. Roy Byrd.

https://www.respiratorytherapyzone.com/respiratory-care-week-guide/

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Respiratory therapists: Vital part of health care team - Brownwood Bulletin

According to Forbes, the healthcare services market exceeds $50 billion, which isnt surprising given the complexity of the interactions between biotechnology companies, pharmaceutical companies, medical device companies, distributors, health care institutions, organized physician groups and other stakeholders. Its also a field that largely works in the background and is involved in a rapidly expanding list of activities, including digital health transformation, market growth, operational efficiency and others.

One such company is Medasource, which was founded in 2000 and falls under the umbrella of the Eight Eleven Group, a leading human capital solutions firm specializing in technology and business support. Both are headquartered in Indianapolis.

Medasources practice areas include Health IT, Business Applications, Revenue Cycle Management and Pharmaceutical & Life Sciences.

Michael Haas, Medasources Pharmaceutical & Life Sciences Vertical Director, describes the company as a national healthcare consulting and project services company."

"We partner with hundreds of customers across health systems, pharma, biotech and device companies across the U.S. to drive clinical research and improve patient care, Haas said.

And they are by no means a small consulting firm. They have significant reach across the United States with 32 physical offices and thousands of medical & scientific consultants on assignment this year.

Haas indicates that they partner with industry leaders to provide the expertise needed across critical functions, including translational sciences, medical affairs, clinical development, safety, research informatics and regulatory affairs. They partner to manage entire projects and complement existing teams.

For example, Haas said, our consultant pool is comprised of the scientific, clinical, analytical, and technical expertise needed to drive research and commercial operations. Additionally, our provider vertical focuses on assisting large health systems and academic medical centers execute clinical research and trials.

The COVID-19 pandemic, Haas notes, has been a disruptive year for much of the healthcare and life sciences industry.

He said that early on, Clinical Laboratory teams and Clinical Trials Offices within their healthcare delivery portfolio came to a standstill, while Clinical Engineering teams rushed to ensure proper inventory levels and functionality of critical equipment.

However, this summer, they have been quickly scaling clinical laboratory teams as COVID-19 testing increased along with growing patient volumes and procedures.

With big pharma, weve focused on consulting efforts around the design, management and monitoring of new infectious disease studies, Haas said.

In addition, Medasource has partnered with numerous state governments, cities and counties to build and manage entire teams to combat the spread of COVID-19 throughout the U.S.

Medasource also has two key Workforce Transformation Solutions, Elevate and Project Patriot. Elevate is an entry-level consulting program designed, to infuse your culture with the best and brightest associate or junior-level candidates, Haas said. Our clients use this program to address succession planning and build cost-effective, scalable teams.

Project Patriot is the companys national Veteran consulting program. It assists all veterans and transitioning military and their families by, he said, engaging, equipping and empowering them to successfully explore careers in the healthcare and life sciences industries.

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MedaSource: Depth and Breadth in Life Sciences and Healthcare Consulting - BioSpace

In truth, COVID-19 only emphasized providers need to diversify by augmenting fee-for-service (FFS) income with VBC revenue streams. As patient volumes and FFS payments dried up, provider performance data shows that savings per case in bundled payment programs remained high and capitated payments continued. Financially, providers who chose to stay in VBC contracts but opt out of the risk associated with COVID-19 patients will likely fare better than those who did not.

Thats good, because there are unmistakable signs that VBC is poised to accelerate.

First, the economic burdens caused by the pandemic have intensified pressure to reduce healthcare spending. Governments, employers and consumers all are demanding greater value for their healthcare dollars. Moreover, the Centers for Medicare & Medicaid Services (CMS) has voiced its intent to double down on VBC and accelerate new mandatory bundled payment models.

Although prior to the pandemic less than 20% of Medicare spending was in VBC contracts, CMS has announced it wants to move 100% of Medicare providers into two-sided risk arrangements by 2025. Likewise, CMS wants half of its Medicaid and commercial contracts in VBC models by 2025and most commercial payers are following their lead.

But even if Medicare fails to reach 100% participation by 2025, the momentum shift is clear. VBC is moving ahead.

Join the race in progress

In some organizations, historical payer/provider tensions fuel a mindset that VBC contracts are stacked against providers. What providers should understand, however, is that VBC arrangements actually offer opportunities to improve care for their patients while also increasing revenue as compared with fee-for-service.

One key to doing so is to join the VBC race sooner rather than later. CMS has offered voluntary VBC initiatives since 2012, which means a sizable number of providers are already gaining valuable experience. Keep in mind:

Manage risk through knowledge

After deciding to make the shift to VBC, there are ways to manage risk and increase the upside potential. To start, providers must understand how each VBC program works and where the risk lies.

There are dozens of VBC options available from both government and commercial payers, and most are complicated. Medicare programs, though challenging, typically are more accessible and transparent than most commercial plans. For that reason, it generally makes sense for providers to make their initial foray into VBC through a Medicare initiative.

Regardless, its essential to understand exactly how a given VBC arrangement works. For example, organizations must know the standards against which they will be measured. Make sure to recognize the biases in the model as well. Regional wage indices, for instance, create better pricing in some markets and pricing disadvantages in others. Similarly, peer-adjusted trend factors in the Bundled Payments for Care Improvement Advanced (BPCI-A) program have created favorable price opportunities for some bundles and negative pricing for others.

ACOs must understand how their benchmarks are set, and how that affects their ability to succeed against those benchmarks. Even the best-designed contracts have biases, so it is imperative to understand what they are and how they could impact the ability to perform within the contract.

Since risk mitigation depends on properly managing episodes of care, providers should also assess their capacity to redesign care pathways. Ask questions such as:

Once providers fully understand how a VBC program works and their capacity to operate within it, data analysis is crucial to risk management. Through data, providers can see whether the juice is worth the squeeze by quantifying risk, improvement opportunities and potential reward.

That process starts with looking at historical performance in the areas where organizations will be measuredsuch as hospital readmission rates or skilled nursing facility lengths of stay, for example. Organizations should evaluate how their providers measure against regional peers on those metrics. Also consider the organizations appetite for loss. In situations where the data identify an unpalatable risk level, providers can use insurance products designed to protect against downside risk in specific programs.

Welcome new opportunities

COVID-19 has solidified the need for VBC; its here to stay.

Although VBC represents a substantial shift in the healthcare ecosystem, providers must not overlook the tremendous revenue potential it affords in addition to its patient care benefits. The transition may seem daunting, but there are ways to box and manage the risk. The earlier providers start down the VBC path, the greater their chances for long-term VBC success.

York is vice president of value-based care at Coverys. Terry is CEO of Archway Health

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Value-based Care After COVID-19: What Healthcare Leaders Need to Know - Medical Economics

The 2020 Neuroscience Expo will host a morning of free online sessions with legal and financial advisers, tailored exclusively to those dealing with a neurological condition and their caregivers.

Living a happy, fulfilling life goes beyond exceptional medical care. It includes caring for the whole person and their day-to-day struggles.

This Norton Neuroscience Institute event gives individuals living with a neurological condition and their family, caregivers, support care providers and others a way to collect valuable information.

Friday, Oct. 23, 9 a.m. to 12:30 p.m.

This years Norton Neuroscience Institute conference will be livestreamed, but space is limited.

Register Today

This years track for legal and financial resources features the following sessions:

Learn how to create a life care plan for you or a loved one.

Jefferey Yussman and Gordon Homes

Living with a disability can be challenging and requires planning for future needs. Youll learn ways you can financially prepare for the future.

Jefferey Yussman and Gordon Homes

If you wanted to know about the importance of having your affairs in order, this presentation will outline the various legal documents that would ensure your peace of mind.

Victor E. Tackett Jr.

Is it time to apply for disability? Where do I begin? Learn the latest on Social Security disability applications and the process of filing a disability claim.

Sam Schad

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Free sessions on legal and financial issues for those with neurological conditions - Norton Healthcare

Digital health, especially telemedicine, is going to play a prominent role in healthcare going forward, a panel at the Cleveland Clinic Innovation Summit said on Tuesday.

The focus on digital health has been spurred by the outbreak of COVID-19. One of the viruses long-lasting impacts is sure to be the rapid integration of telemedicine.

During the panel, Matt Kull, Chief Information Officer of Cleveland Clinic, spoke noted that telemedicine isnt going to be another fad.

On the telehealth perspective, I think thats here to stay, Kull told fellow panel members during the innovation summit. I think thats going to become the norm and its going to allow us to reach more people where they are and ways they want to be met.

Kulls comments echo three physician surveys conducted by Jason Mills, a medtech analyst at Canaccord Genuity. Mills and colleagues also noted the shift to telehealth in a report published April 13th.

"The COVID-19 pandemic set off an accelerated shift to virtual communication in nearly every forum in which humans interact and, similarly, ... the medical device sector is also embracing the virtual worldand will perhaps continue to do so long after the COVID crisis abates, Mills and colleagues wrote.

During the Cleveland Clinic Innovation Summit, the panel was asked if the idea of telemedicine was under-or-over-hyped. Richard Zane, MD, Chief Innovation Officer of UC Health chimed in on the question.

Telemedicine is far under-hyped, Zane said. The future of whatever were going to describe as virtual care is going to scale very quickly and very robustly.

While the majority of the panel agreed the technology was under-hyped, Allistair Erskine, MD Chief Digital Officer for Mass General Brigham offered another opinion.

Virtual is the new black right now, Erskine said. Were at the top of the curve. We went from 100 visits to 12,000 visits a day. But we still have to digitally upscale our providers and we still have to digitally upscale our patients the ones that are not used to navigating across all these new technologies themselves.

He added, we have to worry about payment reform. Right now, its hot because its paid for. In the future, it could not be paid for and then may slip more into a value-based care arrangement. The broad range of digital health is only going to grow in the future. A report from VynZ Research shows the market was valued at $111 billion in 2019 and is set to reach $510 billion by 2025 observing a CAGR of 29%.

Kyle Rose, an analyst with Canaccord said digital health could be vital to help medtech solutions exist in markets where pharmaceuticals solely existed.

Rose wrote, augmented by a coalescence of AI, software, and back-end data analytics, among other factors, which we think will make devices both smarter and increasingly less-invasive, we view novel med-tech interventions well positioned to increasingly capture share in a segment of the market historically dominated by pharmaceuticals, expanding medtechs reach further upstream.

Read more here:

Telemedicine and Digital Health to Set the Tone for Healthcare - Medical Device and Diagnostics Industry

Forbes recently released its 2020 list of the 400 wealthiest people in America, which includes 14 U.S. billionaires who made their fortunes in the health care industry.

The 23 US health care billionaires (and how they made their fortunes)

For the 39th annual "Forbes 400" list, the magazine reached out to more than 700 individuals whom Forbes considered to be candidates. Analysts with Forbes reviewed financial documents, court records, assets, debt, and other factors to determine the candidates' wealth. According to Forbes' Jennifer Wang, analysts also met with the candidates in person, by phone, or virtually. In addition, Forbes interviewed the candidates' "employees, handlers, rivals, peers, and attorneys," Wang reports.

Ultimately, Forbes "took into account all types of assets: stakes in public and private companies, real estate, art, yachts, planes, ranches, vineyards, jewelry, car collections, and more," and "factored in debt and charitable giving" to determine the list, Wang writes. According to Forbes, individuals must have at least $2.1 billion in wealth to make the list. Forbes notes that 10 people who were on last year's "Forbes 400" list fell off this year's list as their fortunes declined "directly" because of the novel coronavirus pandemic.

Overall, the richest people in America, according to Forbes, are:

This year marks the third consecutive year that Bezos has topped the "Forbes 400" list, Forbes notes.

Forbes divided the billionaires on its list into several categories, including those whose fortunes were made primarily in the health care industry. The health care list did not include billionaires such as Bezos, who made their fortunes in other industries but have also ventured into health care.

The U.S. billionaires included in Forbes' health care category, in order of 2020 net worth, are:

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The 14 US health care billionaires, according to Forbes - The Daily Briefing

Tammy Rivera, an Uber driver, is helping healthcare workers each day with the aid of local businesses.

MEMPHIS, Tennessee The pandemic is still going strong in the Mid-South but what about our appreciation for the frontline workers who are still busy helping COVID-19 patients?

Not long ago Tammy Rivera was Ubering a hospital worker and she discovered how one hot meal during a hectic nightside hospital shift can make all the difference.

So she stepped up to answer the call.

Rivera has a unique relationship with Methodist Le Bonheur Germantown Hospital and now when hospital workers see her they know its time to break from the sometimes chaotic shift and enjoy a good meal.

It seemed like a whole parade of ambulances, the waiting room was full. They come out to get dinner and theyre like you have no idea how much this means to us. Thank you so much.

The hospital worker Rivera was driving had worked a long shift and couldn't eat dinner at the hospital cafeteria, because it was already closed.

That's when she came up with the idea for her "Feed the Frontline" fundraiser.

It didn't take long for her to rally the necessary funds from the Germantown community.

When I woke up I had over $4,000 in my Venmo account. Ive been collecting money and buying dinner every night. Last night was our 200th night.

Riveras fundraiser is also helping to support local restaurants and staff.

Its really an example of people putting their difference aside and coming together," she said. "That being the most important thing.

The health care workers really appreciate it.

Its not just a box of food to them. To them, its that theyre not forgotten. That the community is recognizing, man theyre in the trenches.

Rivera is serving about 60 meals a night to the COVID unit, COVID-19 ICU, Le Bonheur ER, and the main ER.

She's served 12,000 meals to date.

If you'd like to help, River's Venmo account is @Tamara-Rivera-26. Her PayPal is wethreesing@gmail.com. Also the link to the GoFundMe page is here.

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How one conversation turned into a fundraiser helping healthcare workers - WATN - Local 24

AUSTIN, Texas, Oct. 7, 2020 /PRNewswire/ --As flu season advances this fall in the United States, Sonic Healthcare USA has launched a multiplex RT-PCR assay that combines testing for SARS-CoV-2 (COVID-19) and Influenza A/B with a single specimen collection. This new offering complements our existing COVID-19 Testing Program that includes both RT-PCR (Molecular) and Antibody (Serology) testing.

Sonic Healthcare USA clinical laboratories and pathology practices are offering this new assay under the FDA Emergency Use Authorization (EUA). The assay uses highly sensitive high-throughput real-time RT-PCR technology for simultaneous detection and reporting of SARS-CoV-2 (the causative agent of COVID-19), influenza A, and/or influenza B in upper respiratory specimens. Nucleic acid from one or more of these organisms may be detectable in respiratory specimens during the acute (symptomatic) phase of a viral illness, and testing should be offered to individuals suspected of a respiratory viral infection consistent with COVID-19 by a healthcare provider.

The Johns Hopkins University of Medicine Coronavirus Resource Center reports more than 7 million COVID-19 cases in the United States since January 2020. According to the American Society for Microbiology, co-infection with multiple respiratory viruses is possible. More importantly, both COVID-19 and influenza are spread by virus-laden respiratory droplets; both infect lower and upper respiratory epithelium; and both cause fever, cough, anosmia, and other respiratory symptoms. The distinction between these viruses can be clinically significant as they do not share the same anti-viral therapy, vaccine availability, or public health implications.

"Our COVID-19 Medical and Scientific Advisory Taskforce continues to lead and advance our test development strategy to ensure we can support our local medical communities as the COVID-19 pandemic progresses through the upcoming flu season," said Jerry Hussong, MD, MBA, the Chief Executive Officer of Sonic Healthcare USA. "It is critical that we offer these latest test advancements to provide clinicians with accurate insights and diagnostics as they manage through the risk of co-infections and other seasonal respiratory viruses while managing COVID-19," added Dr. Hussong.

References:

https://coronavirus.jhu.edu/map.htmlhttps://asm.org/Articles/2020/July/COVID-19-and-the-Fluhttps://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm

About Sonic Healthcare USA

Sonic Healthcare USAis a subsidiary of Sonic Healthcare Limited, one of the world's largest medical diagnostic companies, providing laboratory services to medical practitioners, hospitals and community health services, with operations in eight countries, on three continents and providing care to over 100 million patients each year. Sonic Healthcare USA is a leading provider of state-of-the-art laboratory and pathology services throughout the USA with nine operating divisions and nearly eight thousand US based employees. Sonic Healthcare USA utilizes a federated business model that emphasizes medical leadership and community based testing services to provide outstanding quality and service to the doctors and patients that they serve. For more information, visit the Sonic Healthcare website at http://www.sonichealthcareusa.com.

MEDIA CONTACTS:

Sonic Healthcare USADr. Jerry Hussong, MD, MBAChief Executive Officer[emailprotected]512.531.2216

SOURCE Sonic Healthcare USA

https://www.sonichealthcareusa.com

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Sonic Healthcare USA Enhances Test Offerings with the Launch of Multiplex Assay for COVID-19 and Flu - PRNewswire

In the last few months, thousands regained their right to vote after the governor took executive action in a move that was widely hailed as a huge step forward and the right thing to do.

Of course, this was not here in Florida, but in Iowa, a state with a very conservative state government. Similarly, in Oklahoma and Missouri, Medicaid expansion overwhelmingly passed through a ballot initiative making it 38 states (plus D.C.) that have expanded affordable health care access to millions.

That these very conservative states were able to pass such measures raises the question: Why cant we do the same here in Florida? If anything, it appears the country is moving forward and finding common ground while Florida stubbornly falls behind.

Efforts to put Medicaid expansion to a vote have been met with immovable opposition from Republicans, who hold the majority in the Florida Legislature. Similarly, the governor and Republican leaders in both chambers have gone above and beyond to make it harder for returning citizens to vote.

The lack of progress on voting rights for former felons is particularly glaring. Florida has the worst voter disenfranchisement record in the country, with over 1.6 million Floridians ineligible to vote due to the racist Jim Crow-era laws that overly penalize those who have served their time.

After Amendment 4 passed in 2018 with one million more votes than DeSantis earned to win the governorship, the Republican-led Legislature circumvented the will of the voters by enacting a law that makes the repayment of fines, fees, and restitution a necessary condition to regaining the ability to vote.

A federal judge struck down that law as unconstitutional, but Governor DeSantis successfully appealed the decision; now the case is likely to be decided by the U.S. Supreme Court, as thousands of Floridians remain in indefinite limbo as to whether they will be allowed to exercise their vote this November in an election with perhaps the greatest stakes weve seen in our lifetimes. Its important to note that the leadership demonstrated by other states on this issue (such as Iowa Governor Kim Reynolds' recent executive order) came with none of the ludicrous caveats weve seen in Florida.

Additionally, as we grapple with budget shortfalls spurred by COVID-19, the need to expand Medicaid has become more pressing. We are now only one of 12 states that refuses to expand Medicaid, despite knowing that expansion would extend health care to more than 800,000 Floridians who desperately need coverage, while filling budgetary gaps. We can recover billions of revenue lost during the pandemic and pay for Medicaid expansion by accepting the tax dollars we have already given to the federal government through our income taxes. Expanding Medicaid would also save Florida almost $200 million annually while bringing $14.3 billion in new federal funding over a 5-year period.

All of these harmful decisions circumvent the peoples will and threaten to make our state a backwater. Its up to us as legislators to fulfill our duty to listen to the people who elected us and act accordingly. If some of the most conservative states in our country can find bipartisan consensus to restore the right to vote to returning citizens and expand health care for hardworking families, so, too, can Florida.

Fentrice Driskell, a Democrat, is the state representative for Florida House District 63, serving parts of north Hillsborough County.

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Florida is falling behind on health care and voting rights | Column - Tampa Bay Times

Climate change isn't just transforming our environment and weather it's impacting our health.

Thats why a group of doctors created a new education framework to teach medical residents how to address climate change with their patients.

Up until recently, future doctors lacked guidelines for working with climate change-related challenges, says lead author Dr. Rebecca Philipsborn of Emory University School of Medicine. The American Medical Association and other organizations have now called for health care professionals to heed the call to action, she says.

Experts in health, climate and medical resident education collaborated to design tangible guidelines that fit into what medical residents are already learning in school.

The framework is broken down into three parts: What are the harms to health from climate change? How does climate change require adaptations in our clinical practice? And how does climate change disrupt health care delivery? Philipsborn says.

Climate change is impacting nearly every organ in our bodies, she says, and hurts how professionals deliver quality health care to patients.

Wildfires and air pollution can worsen illnesses or severity of chronic conditions such as respiratory problems and asthma, she notes. And doctors have been noticing new conditions from climate change, she says, such as how extremely hot weather can cause heat-related nephropathy in the kidneys.

Across the board, doctors are observing more and more climate-related risks and challenges, she says. The severity of these illnesses can depend on where a doctor practices.

For example, Philipsborn says, during Hurricane Irma, when there were almost 7 million people under evacuation orders from Florida, we cared for mothers and their newborn babies who were displaced from their homes [and] their support system in this very vulnerable stage of that baby's life.

When shes working with medical students, she reminds them that patients spend more than 99% of their time outside of the exam room. We can't just deliver treatment in this safe clinical space and ignore the risk that patients face in the rest of their lives.

The new framework helps future health care professionals recognize the risks of climate change not only to treat and manage patients but also to prepare patients with the information they need to avoid risks when possible.

To address climate change within the health care industry, medical facilities need to recognize how human health and the environment are intertwined and related.

And if medical professionals goal, under the Hippocratic oath of physicians ethics, is to do no harm then addressing climate change needs to take priority, she says.

Our health care facilities are part of the problem in terms of the carbon emissions that we create that actually does harm to the patients that we hope to serve, she says. The health care industry is faced with this transition to producing less carbon, less greenhouse gas emissions in the care we provide, and I think physicians have an important voice in that discussion as well.

This story is part ofCovering Climate Now, a global journalism collaboration of more than 400 news outlets committed to better coverage of the climate crisis.This Sept. 21-28collaborative weekfocuses on the intersection of climate change and politics.

Want to help improve WBUR's climate coverage?Take this short surveyto let us know what you like and what you want more of from our reporting.

Cristina Kimproduced this story and edited it for broadcast withTinku Ray.Serena McMahonadapted it for the web.

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Doctors Push For Health Care To Address Climate Change In New Teaching Framework - Here And Now

Access to health care has always been a little precarious in northern Somerset County and things got worse three years ago, when 24/7 on-call emergency care ended at the Jackman Community Health Center.

With the nearest hospitals 90 minutes or more away, and the nearest paramedics about two hours away in Waterville in good weather Jackman-area residents needed a solution.

That solution, with its roots in an ongoing years-long effort to involve paramedics in community health care, has been found. The Critical Access Physician Extender Program, a pilot program funded in part with a recent $1.2 million grant, gives paramedics hospital training needed to provide emergency in-clinic services.

The program, while in some ways unique to Jackman, may be a model that will help solve rural health care access issues in Maine and beyond, says Lori Dwyer, president and CEO of Bangor-based Penobscot Community Health Care, which oversees the health center.

Solutions to rural health care access require out-of-the-box thinking, Dwyer says. The program gets paramedics off the ambulance so they can provide care wherever its needed.

Access and speedy care are a huge challenge in our area and all the areas we serve, Bangor and north of here, she says. But its also an issue in many parts of southern Maine.

Expanding care is the only way to solve the access challenge, she says. We cant physician-hire our way out of it.

Photo / Maureen Milliken

Lori Dwyer, president and CEO of Bangor-based Penobscot Community Health Care. The health care system, which oversees the Jackman Community Health Center, is partnering on a pilot program that allows paramedics to provide emergency medical care.

Created and directed by Jonnathan Busko, medical director of the emergency department at St. Joseph Hospital in Bangor, the program provides hospital training that, combined with a telehealth connection to the hospital, allows them to perform emergency care procedures.

The program is a partnership between Penobscot Community Health Care, St. Joseph Medical Center, Scarborough-based North East Mobile Health Services and the town of Jackman. Key to the program is the telehealth connection between the paramedics and emergency room doctors.

Busko, a former paramedic, based the program on a similar one in Alaska and came up with using paramedics in a new and different way, Dwyer says.

Paramedics are really good at the skills piece, says Butch Russell, chief operating officer at North East Mobile Health Services. The doctor is really good at telling if the patient is stable, or needs further care.

The two team up under the program, through a telehealth connection at St. Joseph Medical Center, with the paramedic as the hands-on caregiver and the doctor as the guide.

Russell says the program could take a lot of forms in different communities, and the model in Jackman could even change.

Its still in the development stages, he says. Once its been going for a while, the bigger picture aspects will begin to emerge.

A lot of this project is a credit to how tenacious that community is, Dwyer says. There are 800 people, but it can feel like 8,000.

For many years, the Jackman clinic was run by Mid-Maine Medical Center of Waterville, providing round-the-clock emergency care, as well as primary care and an attached nursing home. MaineGeneral kept the health center after Mid-Maine and Kennebec Valley medical centers merged in 1997 to become the health care system. But it was hard to sustain economically, and in 2014, MaineGeneral pulled out of the primary care end, and PCHC stepped in.

MaineGeneral continued to run the 18-bed nursing home, which provided nurses and 24-hour call service needed to keep round-the-clock emergency care going at the health center. When MaineGeneral closed the nursing home in September 2017, that ended.

At that point, people started saying We need an alternative way to do something here, says Patricia Doyle, the health centers primary care physician.

Photo / Courtesy North East Mobile Health Services

A North East Mobile Health Services truck at Attean Pond in Jackman

Since then, emergency care has been provided by Doyle, on call. Emergency medical technicians in the towns ambulance who dont have the same level of training as paramedics would either meet paramedics from Waterville in Caratunk, about the half-way point up U.S. Route 201, to transfer emergency patients. Sometimes they drove them the two hours to Waterville.

Under the new program, paramedics will work 48-hour shifts at the health center, in apartments created out of the nursing home space.

Theyll be on call, riding along with the ambulance crew on calls that require immediate emergency care, and also provide emergency care at the clinic, connecting with emergency physicians at St. Joseph for support. Theyll also help Doyle provide urgent care during business hours.

Russell, of North East Mobile, says that paramedics are already in Jackman, helping out.

The second phase, emergency room training at St. Joseph, will start this month with help from the $1.2 million Health Resources and Services Administration Rural Telehealth Network Grant that was announced Sept. 10.

The hospital experience will help them beyond just learning hospital procedures, program officials say.

While paramedics go through one to two years of training, there are things that will come up when theyre the provider in Jackman they may have not dealt with before, Doyle says.

You cant just take a paramedic and park them at the door and plunk down an emergency case and say, You take care of this, she says.

Using paramedics to fill the health care gap around Maine has been used to a lesser extent for the past decade, says Jay Bradshaw, executive director of the Maine Ambulance Association.

He says there has long been the need in many parts of Maine. Someone has to be there 24/7 for emergencies, but you dont have emergencies 24/7, Bradshaw says.

Community paramedicine using paramedics for things like home-based health checks and other medical services in rural areas began in the early 2000s. The program gained traction with legislation in 2012 that allowed up to a dozen paramedicine programs where there were health care access gaps in the state.

The program didnt provide funding. That had to come from the community. It was also understood that the paramedics would practice mostly outside of a hospital setting, something only cleared up with legislation this year that allows them to practice in a hospital setting with the permission of the hospital.

Their role was geared to the needs of the community, but it was largely to provide episodic patient evaluation, advice and treatment directed at preventing or improving a medical condition, according to a 2015 evaluation by the state.

Bradshaw says the fact that no funding source was provided was one reason the program is still not widely used. Free isnt a sustainable model, he says.

Some communities, however, have successful programs, though they focus on immediate on-site care and taking the person to the hospital.

Jackman is taking it to another level, Bradshaw says. Its exciting.

Photo / Maureen Milliken

Jay Bradshaw, executive director of the Maine Ambulance Association, praises the Jackman program.

Its always been difficult to recruit doctors to practice somewhere like Jackman.

Doyle, the clinics physician, arrived 33 years before through the National Health Services Corps. program. Most leave after their required service time is up.

Those involved in the program say that it will be easier to hire paramedics, and the program itself may make the job more enticing.

The added training with the Jackman pilot is a pathway to a more lucrative career, Russell says.

There are four stages to emergency medical service providers, beginning with emergency medical technicians and ending with paramedics, but the further clinical training bridges the gap between paramedic and becoming a registered nurse or physicians assistant, he says.

Bradshaw says, too, that EMS is a young persons game. The physical demands take a toll.

But the ability of paramedics to work in a clinical setting and do more of a variety of jobs means it could be a long career.

They already have a career where theyre talking to patients, theyre dealing with emergency medicine, theyre doing procedures, he says. Theyre ideal for it, for a long career.

The grant is also paying for a small similar program in Winterport, where physicians in PCHCs primary care practice can connect with emergency room doctors at St. Joseph to perform emergency care.

Dwyer says that primary care doctors dont have the extensive emergency room training emergency doctors do, and emergency patients are transported to the hospital. The Winterport program will serve the same purpose as the one in Jackman provide emergency services for the town, which is a half hour or more from the nearest hospital, in Bangor.

The grant will also be used to find a way to make the Jackman program, and future ones, economically sustainable.

The tangle of insurance, what Medicare covers, who gets billed and more, can make paying for such programs difficult, those involved with the Jackman pilot say.

Dwyer says that Jackman, while unique, is a perfect place to test it out.

The roads to the closest hospitals arent great roads, theyre not safe roads, she says. In a lot of ways, Jackman is an island.

For such a program to work it has to be collaborative, with buy-in from the entire community. This is a grassroots, bottoms-up community-based health care decision, she says. Its a different way of doing things in health care. Its non-competitive, its inclusive, its democratic. PCHC isnt carrying all the water on this, because we cant.

Of all the partners involved, its the community that was key to making it happen. The community rightfully sees health care as a key to the economy. You cant get tourists to come here if theres no emergency care.

She says that, in the bigger picture, Maine will likely react the same way. Its almost a uniquely Maine approach, Dwyer says. Its Yankee ingenuity. We have this problem, now how do we solve it?

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Closing the rural health care access gap in Jackman, and maybe beyond - Mainebiz

COVID-19 has pushed digital health technologies such as telehealth and remote monitoring /virtual care into the fore, and the nation-state of Singapore is no exception. Its whole of society approach to combating the pandemic, in which the government, private sector and citizens come together as a unit has resulted in an extremely low fatality rate of 0.05% (27 deaths out of more than 57,000 cases at the time of writing).

Another important component in Singapores effective approach in containing the pandemic is the Ministry of Healths method of risk profiling through multi-agency efforts to capture data, and subsequently having tiers to provide different levels of care based on the COVID-19 patient cases severity.

Bruce Liang, CEO of Integrated Health Information Systems (IHiS), Singapores national health IT agency, said during the first episode of the Singapore Digital Dialogue Series that the use of tech, together with the close alignment of the Health Ministrys risk stratification plans, has resulted in the adoption of a care model that is manpower light and tech heavy. With the majority of confirmed COVID-19 cases being relatively healthy, these patients can be managed with the use of remote monitoring tech in newly created Community Care Facilities (CCFs), while manpower can be focused on dealing with higher-risk patients.

HIMSS20 Digital

Never let a crisis go to waste

The telehealth program in Singapore has been running for about three years, and due to the pandemic, the number of use cases have tripled in the last six months with both new and existing users. While it is encouraging to see the significant rise in telehealth adoption, Liang noted that this period is a good opportunity to also iron out workflow issues and reimbursement models.

This is especially crucial in post-COVID Singapore to provide a seamless telehealth experience for both clinicians and patients and maintain or even increase the momentum of telehealth adoption.

Expressing similar sentiments, Dr Keren Priyadarshini, Regional Business Lead, Worldwide Health, Microsoft Asia said that the pandemic has resulted in more openness to try new ways of working for example, her company has partnered with neurologists to adopt mixed reality models for training.

She predicts that a hybrid model can be successful for healthcare in the future a blend of traditional in person healthcare services and telemedicine services like virtual/remote care.

As a result of the pandemic, the healthcare world has seen six major cases of cybersecurity breaches/incidents since June with specific issues like ransomware and botnets which has become a standardized way of attack, explained Evan Dumas Regional Director, South East Asia, Check Point.

Dumas advice for healthcare organizations was to focus on real time prevention rather than reacting to cybersecurity incidents when they actually happen. It is also critical to secure the organizations numerous disparate medical devices and systems as these can become potential points of unauthorized entry. Being able to consolidate these devices and systems, monitor them on a centralized platform will also aid in better overall visibility and enhance incident prevention.

Upcoming priorities

While Liang observed that there was no significance difference in terms of digital engagement with patients during the pandemic period, a key priority in the post COVID-19 period for IHiS is to enhance digital engagement with patients in a less transactional manner. For instance, other than using digital platforms for scheduling appointments and checking lab results, IHiS's focus would be to look at how on to improve the patient service journey.

Another area of challenge would be community care management/post discharge care management, as there are numerous types and varying levels of tech use especially in the private sector, which will be difficult to integrate and collaborate with.

Lastly, with most multiple tech and IT experiments running across most public healthcare providers, IHiS needs to balance between supporting these providers while needing to maintain a system-wide picture, support parallel innovations and ensuring interoperability between systems.

To meet these challenges, a new healthtech master plan has been set in place in Singapore, with the aim of redefining how technology and business partners can work together in the healthtech space.

Click here to register for the next episode HIMSS Singapore Digital Dialogue Series.

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Digital engagement and transformation of healthcare in Singapore - Healthcare IT News

In the past six months, weve seen a huge shift in how doctors practice, how patients receive care and how hospitals respond to crisis.

In our cover story, Medicines new virtual reality, Renee Cordes explains how telehealth went from being an option to a necessity. Story starts on Page 16.

Hospitals have gone through major changes, reducing the elective surgeries that had been revenue generators, and restructuring space to accommodate COVID-19 patients. But, as Laurie Schreiber reports in Safe return to business, theyve also played a key role in helping the business community prepare for a return to the office. See Page 22.

Rural health care continues to present challenges, no more so than during the pandemic. Even EMT service has been eliminated in places where towns look to cut budgets. But, as Maureen Milliken reports in Closing the rural health care access gap, the town of Jackman in Somerset County has adopted a pilot program that brought back round-the-clock emergency care. Some experts are saying the program could be adapted to other rural areas. See Page 26.

Clover Health Care in Auburn tops our list of Maines largest assisted living and skilled nursing communities. See Page 29.

Maine Medical Center is No. 1 on our list of Maines largest hospitals. See Page 34.

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From the Editor: The health care business adjusts to an ever-changing world - Mainebiz

Front-line care workers have been called heroes throughout the coronavirus pandemic. Many of them dont feel like it.

Instead, they feel besieged and traumatized not only by the suffering and death theyve witnessed, but by a health care system they believe is showing it doesnt value them, a disjointed and ineffective governmental response, and members of the public who deny the reality of all that suffering and death.

Tragedy is part of the job for medical providers, but the relentlessness of the coronavirus outbreak is more than most have ever seen, said Nina Wells, a nurse practitioner and the president of the Service Employees International Union Local 121RN in Pasadena, California.

It is the vicarious trauma that is never-ending with this pandemic. And its from all angles, not just the disease itself. Its from the poor management, the lack of supplies, the lack of staffing it just goes on and on, Wells said. You get up and you do it again, day after day, without any reprieve, without any resources for the most part and its just mental cruelty.

There have been more than 6.7 million confirmed cases of COVID-19 in the U.S. and over 198,000 deaths, according to data compiled by Johns Hopkins University. While some of those deaths occurred at home, the rest happened in hospitals, nursing homes and other facilities where doctors, nurses and other staff are the only witnesses to patients final, lonely moments.

You can say were heroes I dont particularly like that term but were definitely not treated as such, said Erin McIntosh, a nurse in Riverside, California.

The mental health effects of the pandemic on health care workers can already be measured.

A Physicians Foundation surveyreleased this month found that 58% of doctors now say they frequently experience burnout, up from 40% two years ago. Half of physicians during the pandemic have had feelings of inappropriate anger, tearfulness or anxiety, 30% report feelings of hopelessness, 8% say they have contemplated self-harm and 18% are drinking or using drugs more.

Yet the same survey found that just 13% of doctors have sought mental health care during the pandemic. Not only do health care workers face the same limited access to mental health care services as everyone else, but the culture of medicine creates pressure to not admit to struggling,

Lonely Deaths And Nightmares

McIntosh works as a code blue nurse, which means shes called in when a patient is in serious trouble. In a typical month, she said, her hospital has 30 to 50 code blues. In April, there were more than 70.

I was just seeing patient after patient crashing and coding. We had a lot of deaths in the hospital and it did affect me, McIntosh said. Im seeing a lot of that in our field, a lot of mental health issues related to what weve been put through these last six months.

In April, McIntosh holed up at a hotel so she wouldnt risk infecting her family. During that time, she had a persistent nightmare that her husband caught COVID-19 but there was no ventilator available for him. In another recurring nightmare, she said, Im hearing code blue after code blue after code blue and I cant get to the patients. It definitely has a toll.

One incident has stuck with McIntosh. She intended to pay a brief visit to a COVID-19 patient who appeared to be stable. The woman asked her to stay and talk. She was isolated from friends and family and just wanted some company. McIntosh chatted with her for about 40 minutes. An hour later, the patient died.

That really hit home with me that not only are these patients dying theyre dying alone and lonely, McIntosh said. Thats just my one example. What about all these other patients that are in the rooms with closed doors, with no visitors, alone? Thats not a good feeling.

Health care providers can feel tremendous guilt that they werent able to do more, wondering if the huge numbers of patients, inadequate staffing and complexity of safety procedures meant they didnt get to someone they could have saved if somehow they had been quicker, McIntosh said.

They also carry intense anxiety about getting sick themselves and passing on the virus to co-workers, patients and their own families.

Nearly 1,200 health care workers in the United States have died because of COVID-19, according to a tally from Kaiser Health News and The Guardian. Two of them worked at McIntoshs hospital; their deaths are the subject of an ongoing lawsuit.

I have seen so many co-workers fall ill, McIntosh said. We all know people that have lost someone.

Compounding that grief is what McIntosh sees as mismanagement inside the hospital. As in many facilities around the country, personal protective equipment like masks is in short supply at her workplace. Directives from administrators about what safety equipment and procedures nurses should follow have contradicted her training and experience. Her hospital cut back on staff even as the high volume of COVID-19 patients demanded more resources, she said.

That was just an eye-opener to me and made me feel like, as a nurse, I wasnt valued. Its all about the almighty dollar, McIntosh said.

Meanwhile, she is confronted by people including some of her own relatives who refuse to believe the pandemic is real or to wear masks, and who want the country reopened.

Its a real slap in the face for those of us who have worked day in and day out, tirelessly trying to save lives, McIntosh said. Thats easy for people to say, but when youre there looking at someones face, holding their hand, FaceTiming their loved ones you cannot know how much that hurts.

Its all making her wonder if she can carry on. When I first became a nurse, my first job, I felt so empowered and so valued because I was making a difference in peoples lives. I dont know that I necessarily feel that anymore, and I think thats what a lot of people are feeling, she said. Nurses are leaving the profession in droves.

Professional Stigma

The pandemic has merely worsened what was already a crisis of health care worker burnout, said Aisha Terry, an emergency physician in Washington, D.C. Terry also serves on the board of directors of the Irving, Texas-based American College of Emergency Physicians.

Research before the pandemic found that as many as half of doctors reported being burned out, and other studies found up to 20% of nurses and emergency physicians experience symptoms of post-traumatic stress disorder. The rate of suicide among doctors is more than double that of the general public. The Physicians Foundation survey found that more than one-fifth of doctors know a fellow physician who died by suicide.

Matters have gotten worse half a year into a pandemic, Terry said, but the underlying reasons that health care workers suffer from mental health problems have persisted for a long time.

The problem is environmental and systemic, Terry said. Health care is increasingly business-oriented and profit-driven, which inherently competes with patients best interests and creates ethical conflicts for physicians. Knowing that financial and other constraints can prevent medical providers from offering the best care causes a moral injury to them, she said.

Whats more, admitting to or seeking mental health care is deeply stigmatized in medicine. Doctors and nurses arent supposed to show weakness or admit that the stress of their work is affecting them, even during extreme circumstances like a pandemic.

The culture that we train in and work in sometimes perpetuates a mentality wherein the toll of dealing with this kind of repetitive trauma to our mental health is minimized as just a part of the job, Terry said.

In addition, some states require physicians to disclose mental health diagnoses and treatments when applying for or renewing a medical license. This further discourages them from seeking help when they need it, she said.

The Hero Thing Just Gets Buried

Jennifer Casaletto, an emergency physician in Charlotte, North Carolina, said there has been no escape from the pandemic and the stress it creates. Normally, she can separate her negative experiences at the hospital from the rest of her life. Not now, she said.

This is one of those things that you dont avoid by leaving work. Its everywhere, said Casaletto, who is president-elect of the American College of Emergency Physicians North Carolina chapter. Its hard to limit your engagement even though you know you need to. Her husband, Jacob Debelak, is also a hospital-based physician and both treat COVID-19 patients.

Like McIntosh, Casaletto has grown frustrated with the spread of misinformation and disinformation about the virus and with people in her community who refuse to cover their faces and take other precautions.

Having neighbors and friends almost working against us is hard, Casaletto said. The hero thing just gets buried because of the amount of folks who are saying its a hoax and who arent willing to care for their neighbors and who dont believe any of the science. It just is really difficult to say, What do you think I gain by this being a hoax? I gain nothing.

The stress that can lead to mental health problems affects more than doctors and nurses. Trece Andrews works in the laundry at a nursing home in St. Clair Shores, Michigan. She said her employer was very dishonest in the early weeks of the pandemic, telling workers that no residents would be stricken with COVID-19. The employer was wrong. Residents fell ill, and then so did employees, Andrews said.

Just like medical professionals, Andrews and her co-workers face risks to their health and the health of their families. Although they arent treating patients, theyre in close proximity to them and to the doctors and nurses who care for them. Approximately 40% of COVID-19 fatalities in the U.S. have been nursing home residents, according to a New York Times analysis.

These conditions have led a number of Andrews fellow workers to quit their jobs, and their replacements often dont stick around once they realize the dangers. This turnover and short-staffing are undermining residents care, Andrews said.

When you guys put your parents and grandparents in a home, you want quality care for them. So if they dont get better or change some of this stuff thats going on in this particular industry, its going to take from the care and the well-being of these residents, Andrews said.

The American College of Emergency Physicians, the American Medical Association and other medical organizations have called for states to relax the requirements that doctors disclose their mental health histories. The emergency doctors group alsosupports bipartisan Senate legislation that would study health care workers mental health and create assistance programs. The bill is named after Lorna Breen, a New York physician who died by suicide in April.

While these workers await relief from the pandemic and help from their employers and the government, Casaletto also pleads with the public for help.

Its all of our responsibility to protect the most vulnerable of society as well as our own families, to make sure that we are taking this seriously, that we are wearing masks when were in public, and that were washing our hands frequently, Casaletto said. Please let us help you. And please know that we are there and have your back.

CORRECTION:A previous version misidentified Jennifer Casaletto. She is president-elect of the American College of Emergency Physicians North Carolina chapter, not the national group.

If you or someone you know needs help, call 1-800-273-8255 for theNational Suicide Prevention Lifeline. You can also text HOME to 741-741 for free,24-hour support from theCrisis Text Line. Outside the U.S., pleasevisit theInternational Association for Suicide Preventionfor a databaseof resources.

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The Coronavirus Is Creating A Mental Health Crisis For Health Care Workers - HuffPost

Im sick and tired of our elected representatives in the Republican Party adamantly refusing to get behind affordable health care for every American, even though their own supporters are just as likely as anyone to lose everything they possess, including their lives, should one of them become catastrophically ill.

Closer to home, Republican Rep. Ann Wagner of Ballwin has actively opposed affordable health care for her constituents, choosing rather to keep it prohibitively expensive and inaccessible while accepting more than $470,000 from corporate political action committees in the health care and pharmaceutical industries.

To add insult to injury, Wagner has been the loyal little toady of President Donald Trump, dismissing, denying, and lying about the pandemics true threat. On March 7, after numerous briefings on this dire threat, she has been quoted as saying, As I said, this is, its clear that the risk to our U.S. public is low. Anyone practicing due diligence at the time knew the reality, of course; however, those folks who solely looked to Trump and Wagner for their cues were at much greater risk, believing it was all much ado about nothing.

Incredibly, Wagner has neither a plan for the health care of her own constituents nor a cogent plan for dealing with this pandemic.

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Letter: Wagner is clueless on health care and the pandemic - STLtoday.com

Matt Bryan, MD, is proud of the recognition that Intermountain Healthcare just received from the Human Rights Campaign as a national equity leader for the health systems dedication and commitment to LGBTQ+ health and inclusion.

The national honor from the HRC, earned by five Intermountain hospitals, reflects Intermountains commitment to equity, inclusion, and to ensuring that all in the community feel welcome and safe when receiving care.

For Dr. Bryan, who serves as Intermountains associate medical director for LGBTQ+ Health, the recognition is nice. But far more important to him is knowing that he and his colleagues efforts to ensure equitable care is available to everyone in the community, including LGBTQ+ patients.

He is already seeing it make a difference in many individual lives.

LGBTQ+ people are an important part of our community. Theyre part of our families, our workplaces, our communities, and our lives, said Dr. Bryan, who had worked at Intermountain for four years in internal medicine before adding the role of associate medical director for LGBTQ+ Health in August of 2019.

Ignoring any important part of our community doesnt help anybody. It hurts everybody, he added. So, this is an effort were taking as the entire Intermountain system to ensure that everyone in the community receives the very best healthcare possible.

Dr. Bryans clinic is still focused on general internal medicine but with a specialization for LGBTQ+ patients. His guidance is helping at other clinics and hospitals throughout the system.

The five Intermountain hospitals earning HRC national designation this year each received the highest score of 100. They include:

Intermountain Medical Center in Murray

Alta View Hospital in Sandy

Primary Childrens Hospital in Salt Lake City

Riverton Hospital

LDS Hospital in Salt Lake City

The HRC uses a scoring system called the Healthcare Equality Index which looks at four categories including patient-centered care, patient services, and support, employee benefits, and policy, along with patient and community engagement.

Dr. Bryan said Intermountain recognizing a persons sexual orientation and gender identity is an important part of their overall health picture. Intermountain knows those in the LGBTQ+ community face some health issues at a higher rate but may be less likely to seek care.

Some examples cited by Dr. Bryan:

Lesbian and bi-sexual women are less likely to get screening services for cancer, and gay and bisexual men are at higher risk for sexually transmitted diseases and HIV.

LGBTQ+ people are two times more likely to experience sexual abuse before the age of 12, and transgender individuals have higher rates of victimization, mental illness, and suicidality.

Younger and older members of the LGBTQ+ community are particularly at risk. LGBTQ+ youth are two to three times more likely to die by suicide, he said.

Younger LGBTQ+ patients are more likely to be homeless, and nearly 60% of LGBTQ+ homeless youth have been sexually victimized. Older members of the LGBTQ+ community are more likely to suffer from isolation and lack of social services and family support than heterosexual seniors, added Dr. Bryan.

Just recognizing these disparities can help make care more equitable because it recognizes that these patients healthcare needs are different, and that they may face more barriers to accessing insurance and healthcare, said Dr. Bryan.

Also important is knowing how to make patients feel more comfortable in disclosing their gender identity and sexual orientation because these factors are often invisible disparities, noted Dr. Bryan.

For this reason, Intermountain now provides a space at the top of patients medical charts for patients preferred name and correct pronouns. Its also why education about LGBTQ+ patient needs arent just designed for clinical staff, but all employees at Intermountain, including call center and front-desk staff.

We need people everyone to feel comfortable walking through our doors. We cant have someone mis-gendering patients or using the wrong pronouns when they call or check in for an appointment, said Dr. Bryan. They may walk out or hang up and never come back. This is vital. This is a process that were continually working to improve on.

The HRC recognition highlighted Intermountains community-focused efforts, such as being a sponsor of the Salt Lake City Pride Parade, and teaming with the Utah Pride Center to create a Take Pride in your Health campaign directed at the LGBTQ+ community that focuses on their mental and physical well-being.

The campaign helps ensure that the Utah LGBTQ+ community knows Intermountain is a welcome resource and safe healthcare environment, said Kevan Mabbutt, executive sponsor of LGBTQ+ caregiver resource group at Intermountain.

We are proud of our leadership teams, Office of Diversity,LGBTQ+ Caregiver Resource Group, and caregivers who have demonstrated our commitment to more just and equitable healthcare, said Mabbutt. This recognition does not signal a victory but is a call to action to truly embody what it means to be a leader in LGBTQ+ healthcare and we are certainly up to the task.

The HRC recognition also cites Intermountains staff training, non-discrimination policies, and equitable employee benefits and policies, including insurance coverage for gender transition, and treating spouses the same in all sense no matter the gender of the people in the marriage.

HRC President Alphonso David said providing inclusive care for everyone in the community has been vital, especially during the COVID-19 pandemic.

The health care facilities participating in the HRC Foundations Healthcare Equality Index (HEI) are not only on the front lines of the COVID-19 pandemic, they are also making it clear from their participation in the HEI that they stand on the side of fairness and are committed to providing inclusive care to their LGBTQ patients, David said.

This is the first time Intermountain applied for the HRC consideration. Jan Stucki, from the Intermountain Healthcare Office of Diversity, Equity and Inclusion, said that Intermountain will apply for HRC recognition at all of its 24 hospitals next year.

We want people to live their healthiest lives, no matter their gender identity, sexual orientation or, in the case of our transgender patients, where they are on their transition journey if they are making one, she said. We have worked hard not just to create equity in care for these patients, but to also ensure that our staff are trained in how to talk to and work with our LGBTQ+ community so they feel welcome.

For more information on the HRC rankings clickhere.

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Intermountain Healthcare: Fighting for greater health and inclusion for the LGBTQ+ community - ABC 4

Walmart is on a mission to bring affordable, accessible healthcare to communities around the country, and that includes Florida, and specifically, Kissimmee.

Walmart has announced that in 2021 they will expand Walmart Health by opening low-cost health care clinics inside their stores in Florida. Positively Osceola communicated with Walmarts communications office, and they responded saying they have not released the locations where Walmart Health will come first, but according to the Orlando Business Journal, Walmart is seeking a construction approval from Osceola County for a 7,500-square-foot expansion of 904 Cypress Parkway in Kissimmee for a Health clinic.

According to Walmarts release, Walmart Healthwill offer low, transparent pricing for key healthcare services, regardless of insurance status. This could especially important for families and individuals that might lack access to affordable healthcare, which we know is an unfortunate reality for so many right now, amid the coronavirus pandemic.

According to the Walmart website, the retail behemoth is committed to helping their customers save money while living better and healthier.

We recognize we can make an impact by increasing access to quality, affordable and convenient healthcare as we invest millions of dollars and expand Walmart Health into Florida, which is home to the second highest number of Walmart stores in the country. Its also where we launched our $4 generic prescription program more than a decade ago, Sean Slovenski, SVP and President, Health & Wellness, Walmart U.S. shared on Walmarts website.

Walmart Health clinics will provide:

Low, transparent pricing for key healthcare services, regardless of insurance status. Care delivered by qualified medical professionals, including physicians, nurse practitioners, dentists, counselors and optometrists. State-of-the-art facilities that offer full-service primary and urgent care, labs, x-ray and diagnostics, counseling, dental, optical and hearing services all in one central facility. Specialized community health resources, online education and in-center workshops to educate the community about preventive health and wellness.

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Walmart to open health care clinics in Kissimmee and throughout Florida - positivelyosceola.com