United States social health care program for families and individuals with limited resources
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Racism Bites Everybody Creating racist policies and ideologies is short-sighted. In the long run, these practices affect everyone, including white people. In 1978, older white voters in California decided they didn't want their tax dollars going towards the funding of education for children who were increasingly non-white. To reflect this, Prop 13 capped property taxes and essentially led to a defunding of public education in the state, which families of every race and ethnicity rely on. Intersectionality History has shown that when the American social safety net becomes beneficial for people of color, support for the policies and programs diminish. For example, criminal justice started to be used more and more as a tool for social management after poverty programs in the 1960s allowed Black Americans to access it. Today these relationships between race and a social safety affect our entire society, across the landscape of labor, education outcomes, and incarceration. Abstract Fears Abstract fears are based on something people believe to be true, even though it is not part of their lived experience. For example, if someone believes that immigrants abuse Medicaid, they will fight against Medicaid as a whole, even if the program would be beneficial for them. Abstract fears and prejudices that are not rooted in reason erode the social contract because they block citizens from making decisions that benefit both their own lives and society at large. FIND OUT MORE: Eduardo Porter is an economics reporter for The New York Times, where he was a member of the editorial board from 2007 to 2012 and the Economic Scene columnist from 2012 to 2018. He began his career in journalism as a financial reporter for Notimex, a Mexican news agency, in Mexico City. He was a correspondent in Tokyo and London, and in 1996 moved to São Paulo, Brazil, as editor of América Economía, a business magazine. In 2000, he went to work at The Wall Street Journal in Los Angeles to cover the growing Hispanic population. Porter is the author of The Price of Everything (2011), an exploration of the cost-benefit analyses that underpin human behaviors and institutions. His latest book is American Poison: How Racial Hostility Destroyed Our Promise (2020). You can follow Eduardo Porter on Twitter at @PorterEduardo
As a financial advisor, David came up with the concept of the three buckets and a quick five-minute presentation to convey the idea to clients. This developed into an hour-long presentation which eventually became the seed of the Power of Zero book. It took David just three days to write the book because the core of the material was already in place. He just had to commit to putting it onto the page. The book was republished in 2018 with new content by Penguin Random House. David is currently writing a fictional story centered around a financial theme that has a lot of real-world applications right now. The plot basically revolves around the very real threat of Modern Monetary Theory. Modern Monetary Theory is the idea that the government isn't constrained by the same restrictions as the average American family and can essentially print as much money as they want without repercussions. All of the economists that David has interviewed for his podcast essentially agree on the fact that implementing MMT would lead to hyperinflation. However, this doesn't stop MMT proponents from espousing the theory though. If you start accumulating debt in the belief that it won't affect anything, reality will prove you wrong. The cost of servicing the level of debt the US government currently has is taking up a large portion of the federal budget. By 2040, it would consume the entirety of the federal budget if interest rates simply went back to where they were at in 2003. David believes the moment of reckoning for the US is going to be 2030. Brian Beaulieu has predicted the major economic trends with 90% accuracy over the past 40 years, and he believes that 2030 will be a confluence of events that will result in a global depression. As rough as the dollar is, it's still one of the most stable currencies in the world. It's relatively unlikely to be usurped. The real issue is that Social Security and Medicaid are tied to inflation, so if we print more money, the cost of the programs also rises and you will never really get ahead. The US is facing down a fiscal gap of $239 trillion just to be able to deliver on the promises already made. The Biden tax legislation has pros and cons for many Americans, but the bottom line is that he's not addressing the underlying problem. It doesn't arrest the slide into fiscal solvency. Politicians are generally reluctant to push anything through right before midterms. If the legislation doesn't get passed before the end of the year, it may never happen. If David were the president of the United States, he would take a page out of Larry Kotlikoff and basically guarantee that Biden wouldn't be elected for a second term. The big focus would be to reform the social programs that are driving the debt, in particular MediCare. Without this kind of action, the national debt will grow by definition. Maya MacGuineas did a study to find what the government would have to do to simply prevent the debt from growing by $1 trillion per year, and she found that they would have to tax every dollar earned above $50,000 at a rate of 40%. There is no way around the math. If we are going to fix this problem, no amount of taxing the rich or everyday Americans will do it. We have to fundamentally reform Social Security, MediCare, and Medicaid to get our country back on track. On Jan 1, 2026 tax rates are going to revert to what they were prior to the tax cuts. If you want to do Roth conversions, now is the time. You have five years to take advantage of the current historically low tax rates. Every year that goes by that you fail to take advantage of those tax rates, it increases the likelihood that you will rise into a tax bracket that gives you heartburn. When it comes to Roth conversions, time is your friend and when time is short they become less appealing. When doing a Roth conversion, you have to be convinced that the tax rate you will pay today will be lower than what you would be forced to pay somewhere down the road. If tax rates are even 1% higher, then it's probably the right move.
Temas de hoy: Situación mundial con la variante ómicron Converso con Juan Carlos Acevedo de Lee Conmigo de la campaña de recaudación de fondos para construir la primera biblioteca infantil en PR. Puedes donar por ATH Movil en LeeConmigo Se agrava la crisis de violencia machista y violencia en general Contra el reloj en el Congreso para los fondos de Medicaid. Todavía pendiente la legislación que incluye además el SSI e incentivos para la manufactura En el limbo proyectos de status ante el Congreso See omnystudio.com/listener for privacy information.
This is the Everything Medicare Podcast hosted by Christian Brindle. It can be found on most major platforms that podcasts can be found. Christian Brindle was raised & brought up around the insurance industry. With his dad being an insurance broker for close to 30 years, Christian had the luxury of being able to learn all about the industry from a young age. Christian has worked with people far and wide on their Medicare plans and has seen close to any situation. Christian believes in empowering people on Medicare by not just finding them a plan, but showing them and educating them on why that plan is a good fit. Christian hosts the most popular Medicare podcast on the internet called The Everything Medicare Podcast, written and published two books about Medicare, and is the founder of his own company that is dedicated to helping people on Medicare everywhere. Don't forget to like and subscribe for more videos! Helping people in Utah, Idaho, Colorado, Washington, Oregon, California, Texas, Virginia, West Virginia, South Carolina, North Carolina, Alabama, Florida, Arizona, Nevada, Alaska, Mississippi, Kentucky, Arkansas, Illinois, Kansas, Nebraska, Maryland, Georgia, Tennessee, Missouri, Indiana, Louisiana, Pennsylvania, Maine, Michigan, Wisconsin. Visit our website for more information: www.christianbrindleinsuranceservices.com Pick up Christian's Medicare Guidance book and learn everything you need to know to make a good choice: https://www.amazon.com/Medicare-Guida... Follow us on social! Facebook: https://www.facebook.com/christianbri... Instagram: https://www.instagram.com/christianbr... Twitter: https://twitter.com/C_E_Brindle #Medicare #Medigap #Insurance #HealthInsurance #Health #Healthcare #Medicaresupplement #MedicareAdvantage #Medicare2021 #Medicarehealthplan #InsuranceAgent #MedicarePodcast Medicare, Medigap, Medicare Supplement, Insurance, Health Insurance, Health, Healthcare, HAS, Retire, Retirement, Social Security, Christian Brindle, FICA, Medicare Podcast, Medicare Advantage, Medicaid, Medicare Part A, Medicare Part B, FICA, FICA Tax, Retirement, Retire
Months after a court ordered Missouri to expand Medicaid, the state has been slow to reach out to hundreds of thousands of eligible residents who could benefit from the public health care program.
In this special edition of Hospitals in Focus, we are sharing a fireside chat Chip recently had with retiring Senator Roy Blunt (R-MO). It was recorded last month at the Federation's Board of Governors meeting. This is a wide-ranging, informative discussion where Chip and Sen. Blunt talk about everything from Medicaid expansion to the growing partisan divide in Washington, DC. After serving more than 25 years in Congress and nearly 50 years in public service, Senator Blunt has a unique perspective on where we are today – and where health care policy is headed in the future. He is also one of the few members of Congress to ever hold leadership positions in both the Senate and House. We hope you enjoy this conversation as much as the audience did.
With the December 5 COVID-19 vaccine deadline approaching, Montana’s health care facilities could lose their Medicare and Medicaid funding from the CMS if they don’t comply and nurses across the state are ready to let their objections be heard through […]
The situation with the Biden infrastructure plan continues to evolve. Senators Joe Manchin and Krysten Sinema have continued to be obstacles in the Democrats' way from getting the bill passed. The Democrat caucus has been in disarray and seems to be pulling in different directions. Biden was hoping the bill would pass by having everyone vote before the legislation was written prior to him landing in Rome. Right now, it looks like things are dead in the water including raising tax rates on the rich. The big question is whether the Trump tax code will remain in place until 2026. Joe Biden has expressed his desire to raise taxes on the rich, and the easiest way for him to do that is to simply let them expire. For most Americans, this means that if you want to shift your money from tax-deferred to tax-free, you have just five years left. The fewer years you have to shift your money, the more likely you are to rise into a tax bracket that is going to give you heartburn. Whatever happens in the next week is going to determine how people plan for retirement in a significant way and is going to determine the legacy of the Joe Biden presidency. Will Congress simply change the laws regarding Roth accounts? Not likely. To do so at this point would cause political and economic chaos. The Roth IRA is also one of the accounts that both the federal government and the average American likes. If anything, the government will try to make the Roth IRA even more attractive in order to raise more tax revenue now. David is currently writing a new novel based on the very real threat of the Modern Monetary Theory to America. There is a massive fiscal gap in the US of $239 trillion dollars which is going to have to be dealt with eventually, but the Modern Monetary Theory has been saying the debt is nothing to worry about. Modern Monetary Theory is becoming more in vogue recently with many politicians advocating it as a solution to our economic woes. Inflation is already here. We feel it at the grocery store and in our everyday expenses, but we are just at the tip of the iceberg. There is no question that inflation is coming, but whenever MMT proponents are asked about it, it's never their fault. We have been practicing MMT for decades at this point, and eventually we will get to the point where interest rates begin to rise toward historical averages. When that happens the interest on the debt will consume the federal budget. Social Security, Medicare, and MediCaid are tied by law to inflation, so when money is printed to pay for those programs their cost goes up commensurately. It's not possible to print enough money to solve the issue. Longevity risk is a major concern for all retirees, and one of the ways to mitigate it is with the 4% Rule, or what some economists now call the 3% Rule. The trouble is the rule is a very expensive way to mitigate the risk. The alternative is with a guaranteed income annuity. The financial industry has accepted the reality of longevity risk and the benefits of annuities in mitigating that risk, but since the standard is to implement that annuity in the tax-deferred bucket it comes with a number of drawbacks and other risks. Some companies allow for piecemeal Roth conversions which allow you to convert that annuity money to tax-free. For people who say annuities are not for them, they aren't going to like Social Security or their company pension plan since they operate exactly the same way. The Power of Zero paradigm basically says that tax rates are going to rise dramatically in the near future, and when you have the majority of your money in tax-deferred accounts like 401(k)s and IRAs, you are at risk. David advocates for five or more streams of tax-free income including the Roth IRA, Roth 401(k), Roth conversions, and LIRP. The LIRP stands out because of its additional features of mitigating long-term care and coming with a death benefit. Very few Americans will be exposed to the estate tax even if it's lowered by Joe Biden. There are strategies you can use to avoid going past that threshold. David's number one tip as a father of seven is that you have to remember to stop and smell the roses along the way. Have a long-term perspective and know there are precious moments that will pass you by. Starting a life insurance policy is like getting married, it only really works if it's until death do you part. You have to make sure you have a list of things in mind when picking a policy. They are long-term contracts so have a long-term perspective when choosing one. Required Minimum Distributions may be impacted by the Secure Retirement Act working its way through Congress right now, but RMDs only affect 20% of Americans since most people will be accessing in excess of their RMD. The death of the stretch IRA is a big deal and puts an emphasis on converting your IRA to tax-free today. Even if you think your tax rate is higher now, it may still be lower than your kid's tax rates in which case you should strongly think about doing Roth conversions today.
Like the inevitable approach of a slow-moving freight train, ICD-11 is on the horizon, heading this way. It's coming.That's why we asked Margaret Skurka to join us for the next upcoming edition of Talk-Ten-Tuesdays: to give you an exclusive update on the new code set for America's health system. Skurka, a member of the National Committee of Vital Health Statistics (NCVHS), participated in describing for the Honorable Xavier Becerra, Secretary of the U.S. Department of Health and Human Services (HHS), recommendations regarding adoption of ICD-11 in the United States. Skurka, having served in healthcare for more than 40 years, will be make her farewell appearance during the next live edition of the weekly Internet radio broadcast.The live broadcast will also feature these other segments:Special Report: Outpatient CDI and E&M: Outpatient clinical documention integrity (CDI) expert Colleen Deighan will return to continue her popular series on a subject that continues to generate listener interest and questions. Deighan will also conduct a listener's survey and report on revised documentation requirements related to office-visit evaluation and management (E&M) services.Tuesday Focus: Former HHS Office of Inspector General (OIG) Special Agent Eric Rubenstein will report on the constellation of new claims audits. Rubenstein is now director of litigation for Advize Health, LLC.The Coding Report: Laurie Johnson will report on the latest coding news that has appeared on her radar screen. News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc., and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.
In this special episode of the 4sight Friday Roundup podcast, David Johnson, founder and CEO of 4sight Health, and Rosemarie Day, founder and CEO of Day Health Strategies, talk about how the state-based marketplaces have become the energetic new platforms for healthcare innovation around the country. Day helped launch the first state-run marketplace in Massachusetts. As usual I moderate the conversation about Rosemarie and Dave's two-part series on state-based marketplaces, “State-Based Marketplaces 2.0,” recently published on 4sighthealth.com. You can read the two-part series here. Mandated by the Patient Protection and Affordable Care Act, state-based marketplaces, originally called state-based health insurance exchanges, offer health insurance benefits to people who can't obtain—or can't afford—health coverage from other sources, including their employers, Medicare or Medicaid. Thought of at first as health-insurance safety nets for unemployed and self-employed people who don't qualify for government health insurance programs, state-based marketplaces have become robust petri dishes for healthcare innovation. Legacy commercial health insurers and entrepreneurial start-up health insurers are using the marketplaces to introduce and experiment with new types of health plans, health insurance benefits and care-delivery models. You can listen to this episode and all our 4sight Friday Roundup episodes on the Healthcare Now Radio Network, Apple Podcasts, Spotify, Google Podcasts and other streaming services. You also can subscribe to our weekly 4sight Friday newsletter. Thanks for listening.
A Polk County judge has ruled the state can no longer block Medicaid coverage for transgender Iowans seeking medically necessary gender-affirming surgeries. An Iowa-based newspaper chain is facing a buyout bid from a hedge fund that has a history of cutting jobs at other newspapers it has acquired. Plus, health experts in the state are warning Iowans that this year's flu season could be severe.
The Centers for Medicare & Medicaid Services (CMS) released the 2022 Medicare Physician Fee Schedule and Quality Payment Program final rule on November 2, and there are big changes to physician payments. In particular, the Medicare conversion factor, which forms the basis for payments to clinicians, will be lowered by 3.7%. There's nuance in calculating the payments, but you can sum this up as most doctors will take a pay cut in 2022. And since the final rule goes into effect on January 1, 2022, doctors will begin feeling the cuts in Q1 revenue. The rule is specific to Medicare, but there are plans to push similar changes in Medicaid and we all know commercial payers tend to follow CMS' lead. We believe this change will have a ripple effect across the industry. On this episode, I talk with Gail Zahtz, CEO at PropHealth, as part of our ongoing Value-based Payment in 2022 series about what doctors can expect in terms of Medicare FFS payment come January 1, 2022. We discuss this as another example of CMS trying to make Fee-for-Service less “comfy” and expedite the move to value-based payment models. Gail helps us to understand what options exist and we lay out a framework for how to evaluate those options. This is a heavy episode, and there are no clear answers. However, there is a known direction and a viable path forward. We'll try to get you moving in the right direction. For full show notes and links: https://thehcbiz.com/177-doctors-just-took-a-pay-cut-vbp-in-2022-with-gail-zahtz-part-3/
Please join first author Yuan Lu and Guest Editor Jan Staessen as they discuss the article "National Trends and Disparities in Hospitalization for Acute Hypertension Among Medicare Beneficiaries (1999-2019)." Dr. Carolyn Lam: Welcome to Circulation on the Run: your weekly podcast, summary and backstage pass to the journal and it's editors. We're your co-hosts. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, associate editor, and director of Pauley Heart Center at VCU health in Richmond, Virginia. Dr. Carolyn Lam: Greg, today's feature discussion is about the national trends and disparities and hospitalizations for hypertensive emergencies among Medicare beneficiaries. Isn't that interesting? We're going to just dig deep into this issue, but not before we discuss the other papers in today's issue. I'm going to let you go first today while I get a coffee and listen. Dr. Greg Hundley: Oh, thanks so much, Carolyn. My first paper comes to us from the world of preclinical science and it's from professor Christoff Maack from University Clinic Wursburg. Carolyn, I don't have a quiz for you, so I'm going to give a little break this week, but this particular paper is about Barth syndrome. Barth syndrome is caused by mutations of the gene encoding taffazin, which catalyzes maturation of mitochondrial cardiolipin and often manifests with systolic dysfunction during early infancy. Now beyond the first months of life, Barth syndrome cardiomyopathy typically transitions to a phenotype of diastolic dysfunction with preserved ejection fraction, one of your favorites, blunted contractile reserve during exercise and arrhythmic vulnerability. Previous studies traced Barth syndrome cardiomyopathy to mitochondrial formation of reactive oxygen species. Since mitochondrial function and reactive oxygen species formation are regulated by excitation contraction coupling, these authors wanted to use integrated analysis of mechano-energetic coupling to delineate the pathomechanisms of Barth syndrome cardiomyopathy. Dr. Carolyn Lam: Oh, I love the way you explained that so clearly, Greg. Thanks. So what did they find? Dr. Greg Hundley: Right, Carolyn. Well, first defective mitochondrial calcium uptake prevented Krebs cycle activation during beta adrenergic stimulation, abolishing NADH regeneration for ATP production and lowering antioxidative NADPH. Second, Carolyn, mitochondrial calcium deficiency provided the substrate for ventricular arrhythmias and contributed to blunted inotropic reserve during beta adrenergic stimulation. And finally, these changes occurred without any increase of reactive oxygen species formation in or omission from mitochondria. So Carolyn what's the take home here? Well, first beyond the first months of life, when systolic dysfunction dominates, Barth syndrome cardiomyopathy is reminiscent of heart failure with preserved rather than reduced ejection fraction presenting with progressive diastolic and moderate systolic dysfunction without relevant left ventricular dilation. Next, defective mitochondrial calcium uptake contributes to inability of Barth syndrome patients to increase stroke volume during exertion and their vulnerability to ventricular arrhythmias. Lastly, treatment with cardiac glycosides, which could favor mechano-energetic uncoupling should be discouraged in patients with Barth syndrome and left ventricular ejection fractions greater than 40%. Dr. Carolyn Lam: Oh, how interesting. I need to chew over that one a bit more. Wow, thanks. But you know, I've got a paper too. It's also talking about energetic basis in the presence of heart failure with preserved ejection fraction, but this time looking at transient pulmonary congestion during exercise, which is recognized as an emerging and important determinant of reduced exercise capacity in HFpEF. These authors, led by Dr. Lewis from University of Oxford center for clinical magnetic resonance research sought to determine if an abnormal cardiac energetic state underpins this process of transient problem congestion in HFpEF. Dr. Carolyn Lam: To investigate this, they designed and conducted a basket trial covering the physiological spectrum of HFpEF severity. They non-invasively assess cardiac energetics in this cohort using phosphorous magnetic resonance spectroscopy and combined real time free breathing volumetric assessment of whole heart mechanics, as well as a novel pulmonary proton density, magnetic resonance imaging sequence to detect lung congestion, both at rest and during submaximal exercise. Now, Greg, I know you had a look at this paper and magnetic resonance imaging, and spectroscopy is your expertise. So no quiz here, but could you maybe just share a little bit about how novel this approach is that they took? Dr. Greg Hundley: You bet. Carolyn, thanks so much for the intro on that and so beautifully described. What's novel here is they were able to combine imaging in real time, so the heart contracting and relaxing, and then simultaneously obtain the metabolic information by bringing in the spectroscopy component. So really just splashing, as they might say in Oxford, just wonderful presentation, and I cannot wait to hear what they found. Dr. Carolyn Lam: Well, they recruited patients across the spectrum of diastolic dysfunction and HFpEF, meaning they had controls. They had nine patients with type two diabetes, 14 patients with HFpEF and nine patients with severe diastolic dysfunction due to cardiac amyloidosis. What they found was that a gradient of myocardial energetic deficit existed across the spectrum of HFpEF. Even at low workload, the energetic deficit was related to a markedly abnormal exercise response in all four cardiac chambers, which was associated with detectable pulmonary congestion. The findings really support an energetic basis for transient pulmonary congestion in HFpEF with the implication that manipulating myocardial energy metabolism may be a promising strategy to improve cardiac function and reduce pulmonary congestion in HFpEF. This is discussed in a beautiful editorial by Drs. Jennifer Hole, Christopher Nguyen and Greg Lewis. Dr. Greg Hundley: Great presentation, Carolyn, and obviously love that MRI/MRS combo. Carolyn, these investigators in this next paper led by Dr. Sara Ranjbarvaziri from Stanford University School of Medicine performed a comprehensive multi-omics profile of the molecular. So transcripts metabolites, complex lipids and ultra structural and functional components of hypertrophic cardiomyopathy energetics using myocardial samples from 27 hypertrophic cardiomyopathy patients and 13 controls really is the donor heart. Dr. Carolyn Lam: Wow, it's really all about energetics today, isn't it? So what did they see, Greg? Dr. Greg Hundley: Right, Carolyn. So hypertrophic cardiomyopathy hearts showed evidence of global energetic decompensation manifested by a decrease in high energy phosphate metabolites (ATP, ADP, phosphocreatine) and a reduction in mitochondrial genes involved in the creatine kinase and ATP synthesis. Accompanying these metabolic arrangements, quantitative electron microscopy showed an increased fraction of severely damaged mitochondria with reduced crystal density coinciding with reduced citrate synthase activity and mitochondrial oxidative respiration. These mitochondrial abnormalities were associated with elevated reactive oxygen species and reduced antioxidant defenses. However, despite significant mitochondrial injury, the hypertrophic cardiomyopathy hearts failed to up-regulate mitophagic clearance. Dr. Greg Hundley: So Carolyn, in summary, the findings of this study suggest that perturbed metabolic signaling and mitochondrial dysfunction are common pathogenic mechanisms in patients with hypertrophic cardiomyopathy, and these results highlight potential new drug targets for attenuation of the clinical disease through improving metabolic function and reducing myocardial injury. Dr. Carolyn Lam: Wow, what an interesting issue of our journal. There's even more. There's an exchange of letters between Drs. Naeije and Claessen about determinants of exercise capacity in chronic thromboembolic pulmonary hypertension. There's a "Pathways to Discovery" paper: a beautiful interview with Dr. Heinrich Taegtmeyer entitled,"A foot soldier in cardiac metabolism." Dr. Greg Hundley: Right, Carolyn, and I've got a research letter from Professor Marston entitled "The cardiovascular benefit of lowering LDL cholesterol to below 40 milligrams per deciliter." Well, what a great issue, very metabolic, and how about we get onto that feature discussion? Dr. Carolyn Lam: Let's go, Greg. Dr. Greg Hundley: Welcome listeners to our feature discussion today. We have a paper that is going to address some issues pertaining to high blood pressure, or hypertension. With us, we have Dr. Yuan Lu from Yale University in New Haven, Connecticut. We also have a guest editor to help us review this paper, Dr. Jan Staessen from University Louvain in Belgium. Welcome to you both and Yuan, will start with you. Could you describe for us some of the background that went into formulating your hypothesis and then state for us the hypothesis that you wanted to address with this research? Dr. Yuan Lu: Sure. Thank you, Greg. We conducted this study because we see that recent data show hypertension control in the US population has not improved in the last decades, and there are widening disparities. Also last year, the surgeon general issued a call to action to make hypertension control a national priority. So, we wanted to better understand whether the country has made any progress in preventing hospitalization for acute hypertension. That is including hypertension emergency, hypertension urgency, and hypertension crisis, which also refers to acute blood pressure elevation that is often associated with target organ damage and requires urgent intervention. We have the data from the Center for Medicare/Medicaid, which allow us to look at the trends of hospitalization for acute hypertension over the last 20 years and we hypothesize we may also see some reverse progress in hospitalization rate for acute hypertension, and there may differences by population subgroups like age, sex, race, and dual eligible status. Dr. Greg Hundley: Very nice. So you've described for us a little bit about perhaps the study population, but maybe clarify a little further: What was the study population and then what was your study design? Dr. Yuan Lu: Yeah, sure. The study population includes all Medicare fee-for-service beneficiaries 65 years and older enrolled in the fee-for-service plan for at least one month from January 1999 to December 2019 using the Medicare denominator files. We also study population subgroups by age, sex, race and ethnicity and dual eligible status. Specifically the racial and ethnic subgroups include Asian, blacks, Hispanics, North American native, white, and others. Dual eligible refers to beneficiary eligible for both Medicare and Medicaid. This study design is a serial cross sectional analysis of these Medicare beneficiaries between 1999 and 2019 over the last 20 years. Dr. Greg Hundley: Excellent. Yuan, what did you find? Dr. Yuan Lu: We actually have three major findings. First, we found that in Medicare beneficiaries 65 years and older, hospitalization rate for acute hypertension increased more than double in the last 20 years. Second, we found that there are widening disparities. When we look at all the population subgroups, we found black adults having the highest hospitalization rate in 2019 across age, sex, race, and dual eligible subgroup. And finally, when we look at the outcome among people hospitalized, we found that during the same period, the rate of 30 day and 90 day mortality and readmission among hospitalized beneficiaries improved and decreased significantly. So this is the main findings, and we can also talk about implications of that later. Dr. Greg Hundley: Very nice. And did you find any differences between men and women? Dr. Yuan Lu: Yes. We also looked at the difference between men and women, and we found that actually the hospitalization rate is higher among females compared to men. So more hospitalizations for acute hypertension among women than men. Dr. Greg Hundley: Given this relatively large Medicare/Medicaid database and cross-sectional design, were you able to investigate any relationships between these hospitalizations and perhaps social determinants of health? Dr. Yuan Lu: For this one, we haven't looked into that detail. This is just showing the overall picture, like how the hospitalization rate changed over time in the overall population and by different population subgroups. What you mentioned is an important issue and should definitely be a future study to look at whether social determine have moderated the relationship between the hospitalization. Speaker 3: Excellent. Well, listeners, now we're going to turn to our guest editor and you'll hear us talk a little bit sometimes about associate editors. We have a team that will review many papers, but when we receive a paper that might contain an associate editor or an associate editors institution, we actually at Circulation turn to someone completely outside of the realm of the associate editors and the editor in chief. These are called guest editors. With us today, we have Dr. Jan Staessen from Belgium who served as the guest editor. He's been working in this task for several years. Jan, often you are referred papers from the American Heart Association. What attracted you to this particular paper and how do you put Yuan's results in the context with other studies that have focused on high blood pressure research? Dr. Jan Staessen: Well, I've almost 40 years of research in clinical medicine and in population science, and some of my work has been done in Sub-Saharan Africa. So when I read the summary of the paper, I was immediately struck by the bad results, so to speak, for black people. This triggered my attention and I really thought this message must be made public on a much larger scale because there is a lot of possibility for prevention. Hypertension is a chronic disease, and if you wait until you have an emergency or until you have target organ damage, you have gone in too late. So really this paper cries for better prevention in the US. And I was really also amazed when I compared this US data with what happens in our country. We don't see any, almost no hospitalizations for acute hypertension or for hypertensive emergencies. So there is quite a difference. Dr. Jan Staessen: Going further on that, I was wondering whether there should not be more research on access to primary care in the US because people go to the emergency room, but that's not a place where you treat or manage hypertension. It should be managed in primary care with making people aware of the problem. It's still the silent killer, the main cause of cardiovascular disease, 8 million deaths each year. So this really triggered my attention and I really wanted this paper to be published. Dr. Greg Hundley: Very nice. Jan, I heard you mention the word awareness. How have you observed perhaps differences in healthcare delivery in Belgium that might heighten awareness? You mentioned primary care, but are there any other mechanisms in place that heighten awareness or the importance? Dr. Jan Staessen: I think people in Belgium, the general public, knows that hypertension is a dangerous condition. That it should be well treated. We have a very well built primary care network, so every person can go to a primary care physician. Part of the normal examination in the office of a primary care physician is a blood pressure measurement. That's almost routine in Belgium. And then of course not all patients are treated to go. Certainly keeping in mind the new US guidelines that aim for lower targets, now recently confirmed in the Chinese study, you have to sprint three cells. And then the recent Chinese study that have been published to the New England. So these are issues to be considered. I also have colleagues working in Texas close to the Mexican border at the university place there, and she's telling me how primary care is default in that area. Dr. Jan Staessen: I think this is perhaps part of the social divide in the US. This might have to be addressed. It's not only a problem in the US, it's also a problem in other countries. There is always a social divide and those who have less money, less income. These are the people who fell out in the beginning and then they don't see primary care physicians. Dr. Jan Staessen: Belgium, for instance, all medicines are almost free. Because hypertension is a chronic condition prevention should not only start at age 65. Hypertension prevention should really start at a young age, middle age, whenever this diagnosis of high blood pressure diagnosis is confirmed. Use blood pressure monitoring, which is not so popular in the US, but you can also use home blood pressure monitoring. Then you have to start first telling your patients how to improve their lifestyle. When that is not sufficient, you have to start anti hypertensive drug treatment. We have a wide array of anti hypertensive drugs that can be easily combined. If you find the right combination, then you go to combination tablets because fewer tablets means better patient adherence. Dr. Greg Hundley: Yuan we will turn back to you. In the last minutes here, could you describe some of your thoughts regarding what you think is the next research study that needs to be performed in this sphere of hypertension investigation? Dr. Yuan Lu: Sure. Greg, in order to answer your question, let me step back a little bit, just to talk about the implication of the main message from this paper, and then we can tie it to the next following study. We found that the marked increase in hospitalization rate for acute hypertension actually represented many more people suffering a potential catastrophic event that should be preventable. I truly agree with what Dr. Staessen said, hypertension should be mostly treated in outpatient setting rather than in the hospital. We also find the lack of progress in reducing racial disparity in hospitalization. These findings highlight needs for new approaches to address both the medical and non-medical factors, including the social determinants in health, system racism that can contribute to this disparity. When we look at the outcome, we found the outcome for mortality and remission improved over time. Dr. Yuan Lu: This means progress has been made in improving outcomes once people are hospitalized for an acute illness. The issue is more about prevention of hospitalization. Based on this implication, I think in a future study we need better evidence to understand how we can do a better job in the prevention of acute hypertension admissions. For example, we need the study to understand who is at risk for acute hypertensive admissions, and how can this event be preempted. If we could better understand who these people are, phenotype this patient better and predict their risk of hospitalization for acute hypertension, we may do a better job in preventing this event from happening. Dr. Greg Hundley: Very nice. And Jan, do you have anything to add? Dr. Jan Staessen: Yes. I think every effort should go to prevention in most countries. I looked at the statistics, and more than 90% of the healthcare budget is spent in treating established disease, often irreversible disease like MI or chronic kidney dysfunction. I think then you come in too late. So of the healthcare budget in my mind, much more should go to the preventive issues and probably rolling out an effective primary care because that's the place where hypertension has to be diagnosed and hypertension treatment has to be started. Dr. Greg Hundley: Excellent. Well, listeners, we've heard a wonderful discussion today regarding some of the issues pertaining to hypertension and abrupt admission to emergency rooms for conditions pertaining to hypertension, really getting almost out of control. We want to thank Dr. Yuan Lu from Yale New Haven and also our guest editor, Dr. Jan Staessen from Louvain in Belgium. On behalf of Carolyn and myself, we want to wish you a great week and we will catch you next week on the run. This program is copyright of the American Heart Association, 2021. The opinions express by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association for more visit aha journals.org.
This is the Everything Medicare Podcast hosted by Christian Brindle. It can be found on most major platforms that podcasts can be found. Christian Brindle was raised & brought up around the insurance industry. With his dad being an insurance broker for close to 30 years, Christian had the luxury of being able to learn all about the industry from a young age. Christian has worked with people far and wide on their Medicare plans and has seen close to any situation. Christian believes in empowering people on Medicare by not just finding them a plan, but showing them and educating them on why that plan is a good fit. Christian hosts the most popular Medicare podcast on the internet called The Everything Medicare Podcast, written and published two books about Medicare, and is the founder of his own company that is dedicated to helping people on Medicare everywhere. Don't forget to like and subscribe for more videos! Helping people in Utah, Idaho, Colorado, Washington, Oregon, California, Texas, Virginia, West Virginia, South Carolina, North Carolina, Alabama, Florida, Arizona, Nevada, Alaska, Mississippi, Kentucky, Arkansas, Illinois, Kansas, Nebraska, Maryland, Georgia, Tennessee, Missouri, Indiana, Louisiana, Pennsylvania, Maine, Michigan, Wisconsin. Visit our website for more information: www.christianbrindleinsuranceservices.com Pick up Christian's Medicare Guidance book and learn everything you need to know to make a good choice: https://www.amazon.com/Medicare-Guida... Follow us on social! Facebook: https://www.facebook.com/christianbri... Instagram: https://www.instagram.com/christianbr... Twitter: https://twitter.com/C_E_Brindle #Medicare #Medigap #Insurance #HealthInsurance #Health #Healthcare #Medicaresupplement #MedicareAdvantage #Medicare2021 #Medicarehealthplan #InsuranceAgent #MedicarePodcast Medicare, Medigap, Medicare Supplement, Insurance, Health Insurance, Health, Healthcare, HAS, Retire, Retirement, Social Security, Christian Brindle, FICA, Medicare Podcast, Medicare Advantage, Medicaid, Medicare Part A, Medicare Part B, FICA, FICA Tax, Retirement, Retire
The Modern Therapist's Survival Guide with Curt Widhalm and Katie Vernoy
Peer Support Specialists An interview with Kemisha Fields, MSW, Amparo Ostojic, MPA, and Jeff Kashou, LMFT on what peer support specialists are and the value they bring to treatment teams, as well as the challenges and best practices in implementing these roles into clinical programs. Curt and Katie talk with Kemisha and Amparo about their experiences in these positions, exploring how their lived experiences created the successful integration of a more holistic approach to support clients. We also talked with Jeff about his journey in implementing one of these programs from scratch. It's time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age. Interview with Kemisha Fields, MSW, Amparo Ostojic, MPA, and Jeff Kashou, LMFT Kemisha Fields, MSW: Kemisha Fields was born and raised in South Los Angeles, CA. As a former foster youth, she has taken a professional interest in the commitment to serving the needs of children and families as a Children's Social Worker working in Dependency Investigations. She has studied many modalities to bring healing to those in need. Kemisha is a life, long learner inspired by the abundance of opportunities available to enrich the lives of the people she serves. She earned her Bachelor of Science Degree in Psychology from the University of Phoenix. She received her Master of Social Work degree from the University of Southern California. Currently, Kemisha is a Doctoral Student of Business Administration with an emphasis in organizational leadership. She has extensive experience working with children, families, and individuals as an agent of support and guidance. Kemisha has a strong background in case management for an array of populations inclusive to at-risk youth, individuals with intellectual disabilities, commercially sexual exploited children, victims of trauma, and families within the dependency system. As a lead Dependency Investigator with Los Angeles County Child and Family Services, she has direct practice with assessing for child abuse and neglect in hostile environments. Kemisha works directly with County Counsel to investigate and sustain infractions of the Child Welfare and Institutions Codes. Jeff Kashou, LMFT: Jeff Kashou, LMFT is a manager of clinical product and service design for a mental health tech company that provides telemedicine to those with serious mental illness. Previously, he ran a county mental health program where he helped develop the role fo peers for adolescent programs county-wide and collaborated with peers to create management practices to support their professional development. In this position, Jeff developed a practice guideline for the utilization of peers in behavioral health settings for the County of Orange. Jeff has also served on the Board of Directors for the California Association of Marriage and Family Therapists, where he helped lead the association to support the field of Marriage and Family Therapy and those with mental health issues. He consults as experts in mental health for television productions, to ensure the accurate and helpful portrayal of mental illness and treatment in the media. Most recently, Jeff and his wife Sheila wrote a children's book, The Proudest Color, that helps children of color cope with racism that will be on shelves this Fall. Amparo Ostojic, MPA: Amparo Ostojic is a mental health advocate with personal lived experience. After working for the federal government for ten years, she decided to pursue her passion in working as an advocate to help promote recovery in mental health. She has worked as a peer specialist for a mental health clinic as well as volunteered leading peer support groups. Amparo has a close connection with the Latino Community and feels it is her duty to do everything possible to prevent and reduce the suffering of individuals living with a mental health condition. Amparo created a Spanish speaking support group in East Los Angeles to offer free peer support to members of her community. Amparo has a bachelor's in business administration and a Master of Public administration. Amparo is a certified personal medicine coach and is working on becoming a National Certified Peer Specialist (NCPS). In this episode we talk about: What a peer support specialist is, how they work What peers can uniquely bring The hiring process, qualifications, and what that means for individuals seeking these jobs The difference in perspective that peer and parent partners can bring to treatment teams The importance of lived experience Comparing holistic versus medical model treatment The medical model and the recovery model complement each other The importance of advocacy for individuals (with the support of the peer support specialist) How peer support specialists are best integrated into treatment teams and programs The potential problems when the peer support specialist role is not understood How someone can become a Peer Support Specialist Certification and standardization of the peer support specialist role SB803 – CA certification for Peer Support Specialists Legislation Ideal training for these professionals How best to collaborate with a peer support specialist What it is like to implement one of these programs The challenges of hiring a peer support specialist Exploring whether there are systems in place to support peer support specialists with their unique needs The recommendation for a tool kit and a consultant to support programs in implementing best practices The Recovery Model and peer support specialists in practice Multidisciplinary teams may have pre-existing bias and prejudice against folks with lived experience, the role of stigma in the interactions The shift that happens when peers become part of the team (specifically related to gallows humor and the separation of “patients” and “providers”) Demonstrating the value of this role and the use of the recovery model Prevention and Early Intervention How to be successful with peer support programs and the benefits at many different levels Our Generous Sponsor: Trauma Therapist Network Trauma is highly prevalent in mental health client populations and people are looking for therapists with specialized training and experience in trauma, but they often don't know where to start. If you've ever looked for a trauma therapist, you know it can be hard to discern who knows what and whether or not they're the right fit for you. There are so many types of trauma and so many different ways to heal. That's why Laura Reagan, LCSW-C created Trauma Therapist Network. Trauma Therapist Network is a new resource for anyone who wants to learn about trauma and how it shows up in our lives. This new site has articles, resources and podcasts for learning about trauma and its effects, as well as a directory exclusively for trauma therapists to let people know how they work and what they specialize in, so potential clients can find them. Trauma Therapist Network therapist profiles include the types of trauma specialized in, populations served and therapy methods used, making it easier for potential clients to find the right therapist who can help them. The Network is more than a directory, though. It's a community. All members are invited to attend community meetings to connect, consult and network with colleagues around the country. Join our growing community of trauma therapists and get 20% off your first month using the promo code: MTSG20 at www.traumatherapistnetwork.com. Resources mentioned: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! RAND Report: How to Transform the US Mental Health System Los Angeles Times Op-Ed: Our mental health laws are failing Wise U Training for Peers Advocacy through Cal Voices ACCESS Program SB-803 National Certified Peer Specialist NCPS Excellent guides and toolkits on how to integrate peers in clinics: Association of Home Social Rehabilitation Agencies Meaningful Roles for Peer Providers in Integrated Healthcare Toolkit Philadelphia Peer Support Tool Kit Relevant Episodes: Fixing Mental Healthcare in America Serious Mental Illness and Homelessness Psychiatric Crises in the Emergency Room Advocacy in the Wake of Looming Mental Healthcare Work Force Shortages Connect with us! Our Facebook Group – The Modern Therapists Group Our consultation services: The Fifty-Minute Hour Who we are: Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch: www.mtsgpodcast.com www.therapyreimagined.com Our Facebook Group – The Modern Therapist's Group https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/ Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/ Transcript (Autogenerated) Curt Widhalm 00:00 This episode is sponsored by Trauma Therapist Network. Katie Vernoy 00:04 Trauma therapist network is a new resource for anyone who wants to learn about trauma and how it shows up in our lives. This new site has articles, resources and podcasts for learning about trauma and its effects, as well as a directory exclusively for trauma therapists to let people know how they work, and what they specialize in so potential clients can find them. Visit traumatherapistnetwork.com To learn more, Curt Widhalm 00:27 listen at the end of the episode for more about the trauma therapist network. Announcer 00:31 You're listening to the Modern Therapist Survival Guide, where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy. Curt Widhalm 00:47 Welcome back modern therapists. This is the modern therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is part four of our special series of fixing mental health care in America. And today, we are shining a spotlight on peer support specialists and the role that they have in our behavioral health care system. And a lot of the advantages that these kinds of roles bring in, as well as some of the difficulties of getting peer support implemented despite a lot of very positive evidence in their role in treating mental and emotional disorders that happen in our world. Katie Vernoy 01:27 I'm really excited about this particular episode, we've got two sections. The first one is we're joined by two folks who've worked in the peer support specialist role who are both still in social work and in advocacy. First off, we've got Kemisha Fields, who's a Master of Social Work who is was actually somebody I worked with, and she did a great job in one of the programs I was running. And then also person I was introduced to by one of our amazing friends of the show on Amparo Ostojic, who is an MPA and also someone who works in advocacy specifically about peer support specialists. So I'm really, really looking forward for all of you to listen to that and learn about what that role is. And we recognized also and I, I had a little bit of this, but Jeff Kashou LMFT is someone who has in the past actually implemented one of these programs, and he was able to talk with us about what it was like as a director, putting those things together. So take a listen. Kemisha Fields 02:30 So my name is Kemisha Fields. I enter social services call for like 17 years ago, I took a entry level position at a homeless shelter. So that was my entry into social services. And from there, I've just kind of progress and work my way up. And I've worked with different populations. So I've worked with the homeless population. I've worked with individuals who are struggling with substance abuse. I worked in recidivism. I've worked in community mental health, and now I'm working in the child welfare system. Amparo Ostojic 03:10 So my name is Amparo Ostojic. And I've been in mental health advocacy and peer support. For the last four years, I have worked to increase awareness about mental health, especially in the Latino community. And I worked as a peer support specialist for a mental health clinic for about seven months, I currently still do advocacy in the mental health space. And I work with individuals that want to know more about how to live, a quote unquote, normal life, even with my severe mental health condition. Curt Widhalm 03:50 A lot of mental health clinicians, they may have heard of a peer specialist. I have found that a lot of my travels and talks in therapist communities that many people don't know what a peer specialist does, can you help us understand what a peer specialist does what their role is in the bigger part of the treatment systems. Amparo Ostojic 04:13 So a peer specialist is basically a role model of positive recovery behaviors. So it's meant to give hope to someone living with a mental health condition and help them not feel as alone in this recovery process. So, in essence, a pure specialist will share their personal lived experience of mental health and oftentimes offer examples of what it's like to deal with a condition. And you know, what they've done to get better, such as tips or a really useful tool is, for example, the living successfully plan or the wrap plans, where you go over with a client what it is like to be in a healthy space, what it's like to see warning signs, and when it's time to call your psychiatrist or go to the hospital. So kind of teach them about themselves and guide them in their self determination of managing their their health condition. Katie Vernoy 05:17 So you're really talking about from a place of your own experience and knowledge helping someone to plan for themselves, Amparo Ostojic 05:26 right. And a lot of it is teaching them to self advocate for themselves, and put themselves in the driver's seat of their health condition. So for example, a lot of times, it's kind of directed from the top as if the psychiatrist or therapist is telling them what to do, or kind of teaching them what they should do. Whereas if your specialist is on the same level, and there's no sort of hierarchy of who knows more, there's a relationship of learning from each other, and really sharing what it's like to live through this. I was given the example where it's like, Is it someone that you want to work with, like someone that's like a biologist that knows about like the forest or something or someone that lives in the forest, because that personal lived experience is really key to understanding things that someone else that hasn't experienced them wouldn't really know, or perhaps hasn't dealt with. Curt Widhalm 06:26 When you started in this, you started as a parent partner, how was that process of getting hired? Kemisha Fields 06:34 So the qualification for a peer partner or parent partner would be a life experience in one of the systems of DCFS, Department of Children and Family Services, probation, and I believe education, like do individual education plan. And so my entry into being a parent partner was through my son's IEP, Individual Education Plan. And, you know, it just kind of happened by chance, a friend of mine recommended me for the position and I follow through with it, the interview process, or the application process, they I was asked what my qualification to being a parent partner, so I did have to disclose some important information regarding my own experiences with my son. And we just, I remember asking, like, anybody could have kind of said, like, oh, yeah, I have this child that has a special needs, like, how did they confirm that information? So I was looking for them to kind of want some sort of documentation from me, and they didn't. And so, at the time, the executive director says, usually confirmed based on the series of questions they asked me during the interview about different programs that may have been introduced to, to my son, which I found quite interesting, like, Okay, Katie Vernoy 08:07 how was it for you to disclose personal things to get a job, because that seems like that would be a pretty vulnerable way to enter into a position. Kemisha Fields 08:19 Very much so and because it's the opposite of what we've always been told, typically, in interviewing process, you don't share too much personal information, just your professional history. So it was a little different. But I always been transparent with my struggles with my son. So it was it was just a little different in I didn't know this person, but it was okay. I you know, I feel comfortable through the process. And I didn't, it was okay for me to, you know, share my experiences. Being a parent of a special needs child. Curt Widhalm 09:01 I have to imagine, and this is prior to being hired in this position. Did you have somebody serving in that kind of a role for you, somebody that you relied on while you were going through your child's IEP process and all of the struggles that that usually entails? Kemisha Fields 09:19 That is... I love that question. I absolutely love that question and Yes, but very informal. So I did not have a formal being like, Whoa, this is your parent partner, and she or he's going to help you through this process. What I have was professionals who kind of just stepped up I had one of the very first school psychologists who helped me through the process of my son's assessment, what to look for what questions that I should ask and she helped me not on a professional level but a personal level. She kind of walked me through that process. So I was grateful for that. So I've had a lot of support with my son, just from individuals who cared enough to show me what this looks like and what questions I should be asking. So I appreciate that. Curt Widhalm 10:20 I have to imagine that working with the mental health systems, the people in those roles, there has to be some difficulties in getting integrated into the more professional sides of the organizations, what kinds of challenges to peer specialists end up having, trying to help clients be able to advocate for themselves and fit into this professional system as well. Amparo Ostojic 10:45 The professionals, such a psychiatrist, therapist, they usually operate from the medical model, which is very top down, like I mentioned, and it kind of has this perspective that I no more in teaching the patient how to, you know, work with medications, or live with this condition, where as peer specialists work from the recovery model, that look at everything, the main four points are home, community health, and purpose, that's really important, like your reason to get up in the morning, right? That sometimes the recovery model is not taking us seriously, it's a more kind of holistic approach, looking at the person. And in the medical model, you're looking at the condition like it's a problem to be solved. And I'm looking at the person as the whole and how their whole life could be better. So my focus may be different than a psychiatrist, their focus may be to reduce the symptoms, and let's say get rid of hearing voices, things like that, or as my role is really to make that person as a whole better. So for example, I usually medications is a big thing must take medications, or as my role may not necessarily say that I typically never tell the client, you know, don't take medications, but I really allow the client to the side that and some other parts of the medical team may not like that. But also, my role may not be taken as seriously because, for example, in my experience working with a mental health clinic, they worked with people that were homeless, and I would say extreme cases. So as someone with bipolar disorder, they kind of put me in this category that, you know, I probably couldn't offer as much. And my perspective wasn't as valuable. So it was really hard. Working with therapists or psychiatrist that saw me as someone that was in the space of like, part of the problem. I don't know how to describe it. But it was really hard, because at the beginning, I definitely felt like I wasn't taking seriously. And it took a while to gain trust, and get there super for me clients. And those were one of the challenges, Curt Widhalm 13:01 I have to imagine some of the providers are like, you're just completely undermining all of the treatment by using trust, none of this professional experience that we've learned. How did those conversations go? Because it seems like so much of a treatment plan would be developed from, you know, the scientific and medical model sorts of approaches. And then for somebody to come in with lived experience to be able to be like, maybe the medication thing is something that you want to talk to your doctor about. Amparo Ostojic 13:33 Well, I take medication, and there was five years that I didn't from when I was 20 to 26. And I was fine. I think, you know, I used to run marathons, I was super fit. And there was a time that I didn't think I needed medication. But then having more episodes, I realized that it does benefit me. So I never really tell a client, don't take medication. But I'm not as I guess pushy into that they may need I needed something to happen for me to sort of learn my lesson and realize, you know, it's it's easier, my life is a little easier with medication. And that may not be the case for everybody. So I definitely don't think they see it as me undermining them. But the recovery model and the medical model are supposed to complement each other. And I think that's the hesitation at the beginning. There's no better treatment or a they say they're supposed to complement each other and offer a level of understanding and acceptance and validation that sometimes the professionals can't offer because they haven't lived through that. So for the most part, I'm never, you know, moving them away from medication or therapy and validating their experience but perhaps they may tell me, you know, I didn't like my psychiatrist. And this is what happened. And I will be honest and say I've had psychiatrist that didn't work with me and didn't work for me. And I had to find a different one. Or I had to advocate for myself and say, you know, this side effect is, is not working for me, you know, maybe this is working, like, the symptoms are, you know, improving. But, you know, it's, it's making me sleepy, and then I can't get to work on time, things that are important that sometimes I think clients are afraid to say, because, you know, like, the main symptom that they're after is maybe under control. But other aspects of your life have completely lost balance now. Katie Vernoy 15:42 Yeah, I think for me, and I was that person at one point. So Kemisha Fields 15:46 You were! Katie Vernoy 15:48 But I think the thing that felt very powerful when I entered into that program, and saw how it was set up was that the team had set up this structure to make sure that each member at the table was heard that each person was allowed to share ideas. I had been in other programs where folks were subjected to that hierarchy, where the therapist or the psychiatrist got the most air time, they're the ones that were making the decisions. And to me, I think, whether it was making sure that the parent partners were supervised by the director, and or really having a culture of, we are all here supporting the family. And we all equally bring important things to the table, I think it was really effective. I think we just get worried because I did see even with programs that were and maybe it was because it was intense now that I'm thinking about it, because like less intense programs, sometimes folks were using either parent partners or bachelor level providers to do like, copying and filing. And it's like, no, no, these are mental health providers, these are people who are at the table. And so to me, I think when when people are able to integrate into the team, it can be really good. Kemisha Fields 17:05 My personality type wouldn't have allow for that, if I'm honest. Like no. And I think when you come in and you kind of demand a level of respect, you get that level of respect. So I've never had a problem, I think, in my whole career of value, my experience as a parent partner, it laid the foundation for so much of the work that I do now. So I'm still connected to a lot of those colleagues, who at the time were clinicians and I, at that time, I wasn't even I had not completed my undergrad studies yet. And we're like the best of friends. So my experience as a parent partner is one that is really great. And had you know, a lot of good things have come out of that for me, Curt Widhalm 17:59 I want to change the conversation here a little bit to talking about how people can become peer specialists and what the certification process is like. And I understand that that's quite different in many different parts of the country. Amparo Ostojic 18:15 Yeah, and even within California, each county has different guidelines. So first of all, California just passed SB 803, which is going to allow pure support specialists to have a certification, which will hopefully increase the use of peer specialists in mental health clinics. So 48 states now have peer certification, including California. And the, the principles are pretty much the same. But how a peer support is used in different parts of a state or country is going to vary. So it's difficult if someone moves to another state or another county, and they try to use the same principles. It may not work as effectively. And it's basically it's not standardized right now. So it's hard for someone working in that field to have many options of going to different places, and even like a client that's moving from another county and experiencing pure services in a different way. Katie Vernoy 19:26 So if someone were to want to jump into this, where it sounds like it's starting to become more regulated, there's certification in 48 states, that's great. What does it look like? How does someone become a peer support specialist? Amparo Ostojic 19:39 There's a few organizations that are considered certified to train for peer support. And, for example, the training that I took was an 11 day course, where, you know, like 40 hours a week, and you learn the principles of peer support. And then To become a certified peer specialist, you need 3000 hours of supervised work or volunteer experience providing direct peer support. And you need a letter of recommendation from a professional and from supervisor that has overseen your peer support. And then there's an exam that you would take and pass. And that's how you would become national certified peer specialist. And on top of that, like I said, California is still in the process of creating their peer support guidelines. So in addition to that, you know, whatever guidelines that they'll come up with will be the California guidelines for certification in California, Curt Widhalm 20:45 a lot of research gives you more credit than being a middleman, that when we look at outcomes for treatments, when we look at treatment, we see that peer counselors, we see that parent partners are more effective towards client outcomes than even just working directly with licensed professionals. And a lot of it is due to a lot of the problems that therapists just kind of face and being approachable themselves for the mental health system themselves that there is a down to earth Ness that having that lived experience really does embody that, yes, you can get through this. And I've got some experience to be able to say that not only do I actually demonstrate that I know what you're going through, but that you can get through it, there's a way through this, that there is a light at the end of the tunnel. How do you think that peer partners, peer counselors can be trained should be trained to best exemplify that part of treatment, Kemisha Fields 21:51 I would say they should be trained the same way that any other team members trained in I know, from a clinical perspective, there's a different type of training that comes into play. But for our child and family team specialists that you know, we have trainings, usually agencies are sending you out to different trainings, and I I believe that parent partners should be a part of those trainings, if they are not already a part of those trainings. And that should and will help them in their role as a parent partner with the life experience on top of that, Katie Vernoy 22:32 how can therapists psychiatrists, other people in mental health clinics, support peer specialists? Amparo Ostojic 22:38 one of the most important parts is understanding and learning to see how we can be used. I think, once you collaborate with a peer specialist, and notice the different perspective that they offer, I think both psychiatrists and peers, and mental health professionals, other mental health professionals can learn from each other. And I really appreciated that with one of the psychiatrist that he like, I could see that he really learned from me, and that gave me a lot of confidence. And I learned a lot from him. And it didn't feel like a top down relationship. And it really felt like he valued my perspective as a professional. And that helped a lot because basically just have faith in in something even if you don't understand how it works. You want to try and see how you can work with this person and encourage them to do actual peer support. If at first you don't know what to do as far as how to work with them. There's really good guides. There's one that I really recommend, that is put out by Castro. And they are basically recovery organization. And they have it's called the meaningful roles for providers in an integrative healthcare. And they really break down the different positions that peer specialists could do the different roles so like a peer navigator peer advocate, wellbeing coach is sometimes what they call it. And it really spells out things that a peer specialists can do. And it helps both the pure and the professional because they will say, you know, they could serve as a bridge between the community based organization, they could help clients in enrolling with health insurance programs, they it really spells out things that a client can do with a pure specialist, and that helps both the pier and the clinic. Katie Vernoy 24:53 How about letting us know a little bit about if someone's interested in this I think from many different angles I wanting to advocate for better utilization of peer support specialists within mental health programs advocating for swift implementation of SB 803. For California, you know, or even this advocacy for individuals who are navigating mental health concerns themselves or with their family members, and how they can advocate like, it seems like there's a lot of lot of potential calls to action for our listeners here. What resources would you recommend that they look into, and we'll put all of those in our show notes. Amparo Ostojic 25:33 So definitely the I would guess, I guess, I would say, one of my favorite organizations that I worked with for the past two and a half years is Cal voices. And they have different programs, the advocacy space, is access. So access stands for advancing client and community empowerment through sustainable solutions. So they're kind of a systems change perspective. And they have really great e learning toolkits that give you tools on how you would advocate for yourself and for systems change within your community. One of the great resources that Cal voices has is their Ys program, which stands for workforce integration, support and education. And they have what they call the YZ University. And it's created by peers, it's taught by peers. And this is where I got my training for becoming a peer support specialist. And they basically provide a lot of support in what a peer does. And like they have wise Wednesdays, where they provide information about something related to peer support and learning about how to, you know, either be a peer specialist or work with a peer specialist. And that's everyone's they. And so, it's a great program, because like I said, it's peers that are teaching and creating the curriculum. And I think that's just wonderful because receiving that information for someone with the lived experience is very powerful. Curt Widhalm 27:21 Switching gears here and talking about the implementation of peer support specialists, here's our interview with Jeff Kashou. We are joined by Jeff Kashou, a licensed Marriage and Family Therapist. He's a former Service chief who oversaw collaborative behavioral health program in Orange County, and had opportunities to oversee the implementations of peer counselors into some of the programs. Jeff Kashou 27:51 Yeah, well, first off, thank you for having me on. And I'm very much appreciated that you guys have this podcast and give the opportunity for topics like this to be covered. Katie Vernoy 27:59 The thing that I find very interesting about these roles that I know you and I both have hired these roles, but people have to claim lived experience in order to get these roles. And so it's it's a very interesting line to walk. There's there's very interesting things there. But what do you see as the difficulties that are associated with hiring peer counselors? Jeff Kashou 28:20 Yeah, so I think, very specifically, what makes the role unique and special also makes it kind of a unique challenge in the interviewing process? How do you ask about one's lived experience as a direct, you know, in theory qualification to have that job is what makes it a unique role to a to an organization or an agency. So I would, you know, really encourage anybody who is looking to start a peer program to bring on a consultant who can really help you think the process all the way through and how to have those conversations without inadvertently walking into equal opportunity ramifications or accidently discriminating against someone while also being very mindful that you're bringing into the room into the interview room and process someone's vulnerabilities. And so being able to manage that very tactfully and professionally, while also ensuring that this person, you know, feels comfortable to share that as well. That's your first introduction to somebody and they're interviewing you in that, that process and they want to ensure that your program has really thought through how they're going to be not just added to their system of care, but how your entire system of care embraces and is made better by having peers on board. Oftentimes peers are looked at as very client facing but really in the best situations for them are those for the entire service model is made better by their presence. Curt Widhalm 29:48 A lot of the talk that we've had on this show about how programs barely take care of their mental health professionals within the work systems. Is there any management that is actually being put towards looking after peer counselors in this way without infantilizing them. I mean, if we're not doing this with the brunt of the behavioral health health workforce, are there other implementation problems when it comes to ensuring this kind of stuff or incorporating them into treatment teams, Jeff Kashou 30:19 when I created a practice guidelines of like best practices for the entire Orange County systems, and not just County, but the entire behavioral health system for how to conduct supervision with peers, I leaned very heavily on a toolkit that I found from the city of Philadelphia, that there Department of Behavioral Health and intellectual disability services put together on how to create a peer support system, from the first moment you decide you want to all the way through to supervising them to managing disciplinary things to supporting their growth. And looking at it even from you know, how is the entire system set up to support them, even the interactions that they have within the multidisciplinary team, you know, they face an additional layer of potentially of scrutiny or challenges by constantly having to explain who they are, why they have any authority to work with patients or clients. So there's, there's added stress to the question or the systems in place to actually take care of them. You know, I would really look at that toolkit that the city of Philadelphia put together as sort of a way to evaluate if your system is there, I'd say, it's certainly lacking just to be completely blunt, the county that I worked for, from the children's behavioral health side was not equipped at the time to take them on effectively. And it required a lot of having to build the plane while you fly it, which I think for some roles, it's okay. I think for peers, it can add additional stress. And it means, you know, workplace ambiguity is stressful enough. But when it comes to all the other challenges of integrating them and supporting them and explaining their role, and giving them the right training, and so on, and so on. There's just another level that needs to be thought all the way through. Curt Widhalm 32:11 How are pure counselors implemented into treatment teams, and how are their voices in actual practice, kind of placed into the role where there's a bunch of other potential licensed professionals across a wide variety of interdisciplinary systems? Jeff Kashou 32:30 Yeah, so I can speak to my experience, and then also kind of broadly to and the research that I've done on the topic. So it's often implemented as a top down approach, it's, you know, people in leadership, saying, we're gonna add this program to our larger organization, without ever really embracing maybe the full scope of what it means to engage in a recovery service model, which is really antithetical to the principles of the peer program, you know, which is meeting people where they're at. So a system of care, really understanding from the bottom up what's happening on the ground level, that's really where the entire program began with. But the ways that they're being implemented, we have that additive approach that systems of care will take. And from a very top down perspective, oftentimes, systems need a way to recoup revenue by bringing on this workforce and, you know, supporting the work that they do. And so when it comes to Medicaid, for example, it's involving them in the billing system. So it requires choosing a diagnosis for the person from the list that the other providers have diagnosed the individual with, which is sometimes very new and a bit challenging. I think, sometimes for peers who don't want to necessarily see someone as a diagnosis. But you know, our current system of billing practices and documentation practices requires that also, multidisciplinary teams really don't know about peers, and can have a lot of prejudice as they go in. So systems need to really be thoughtful and do a self assessment before they decide to bring on this very important role, you know, on are this system set up? Or what are the prejudices or preconceived notions that other providers on the team have of people that come in with lived experience? Right, you know, oftentimes, we have that sort of gallows humor as providers when we talk about our patients or whatever. But, you know, now you have to be very mindful of that, not just because you don't want to upset somebody, but due to having that internal shift of like, you know, I actually really maybe need to check myself when it comes to that, and why I engaged in something like that in the first place. So really thinking about decreasing the stigma and helping the rest of the team even before peers come on, understand what it is that they do, the value that they add, and how they're going to be just as important of a member of a treatment team. So really leading with the why through this process. They're often brought a board you know without much structure I Which, you know, leads to them being assigned a lot of admin tasks as well. One of the things that I learned a lot when working with pure forums was that peers are often assigned, you know, a lot of filing tasks or, you know, paperwork kind of tasks, because the program wasn't really trained or made to be aware of what appear is going to do. And so managers will get, you know, assigned X amount of peers and hire them on but not really know what to do or may not have the bandwidth to train them and think through that whole job requirement. Similarly, what I experienced was, sadly, even partway through the interview process, we found out that we were actually interviewing for peers, but the program was set up, they had to find a job title or job classification that they could fit these folks within, so that we can hire them in a timely manner. And so when we were hiring mental health workers were actually supposed to be hiring peers. And so we found out midway, that we were hiring peers, which meant as managers, then we had to shift and reevaluate what we were doing which we put a lot of emphasis and fervor and figuring out and making it a smooth process as much as we could. But it was by no means ideal. And the cohort that we hired, certainly struggled with a lot of the ambiguity and sometimes just having to sit around and wait while we figured things out for them. Katie Vernoy 36:16 You've mentioned a couple of times the the money element of it, that oftentimes these are folks who are hired to do an important service that isn't always reimbursable. And it makes me think about the value. And this speaks to the prejudice as well. But it makes me think of the value that people hold for this role. You know, they're not generating revenue, typically, or not generating a lot of revenue. They're not seen as experts, although they're oftentimes more expert than the folks in the room that are doing the treatment planning. And so what are the ways that you have found whether it's best practices or what you were able to accomplish in your program, of integrating these folks more successfully into, you know, kind of explaining the role? Like, why is it so important? What is the value of this? Because I feel like, and maybe you've already said this, and maybe this isn't needed, but it does feel like there's a case for this role. There's an importance to this role. And I just feel like maybe we need to be more direct and saying it, I don't know. Jeff Kashou 37:25 So yeah, so there's really two directions to think of when it comes to how do you demonstrate the value, there's two those who would be, you know, deciding to bring on this role, which would be those key stakeholders. And then you also have the provider teams as well. And then I guess, there might even be a third group, which are the patients or clientele that you would be serving. So when it comes to demonstrating the value, I think the message needs to be pretty clear all the way through, which is when you're working with, you know, with individuals with serious mental illness, or those with CO occurring disorders, some of these more serious conditions, we know we preach about prevention and early intervention. And this is the rule that really helps with that. And this is the rule that allows us to make that big shift towards a recovery model, and not just pay lip service to saying that, you know, we meet our patients where they're at, and, you know, we want to, you know, improve the quality of their lives and help them reach their full potential. Now, that's, you know, a bit more idealistic and trying to sell it maybe to those that population level into the stakeholder level, but to the provider team, it's also a matter of, you know, recognizing that they will complement the services that, say, a therapist or psychologist or psychiatrist provides as well. And so it's more of like a meshing of gears versus like, people running off into separate directions, you know, where we know that metod here, it's a very important thing. Medications is a very important aspect of treatment. And if individuals, you know, go to their psychiatrist and they prescribe them an antidepressant, we oftentimes know that adherence drops off very quickly, either because the person has some sort of side effects, or because they start to feel better, and they decide they don't want to take the medication anymore. What you know, for multitude of reasons, here, the peer can actually meet with that person, you know, right after they meet with a psychiatrist, or maybe even be in the room with them when they meet with a psychiatrist. And help them ask the questions that are there might be uncomfortable asking, or ensure that they're asking the questions they didn't think to ask, creating that plan afterwards with them for how they're going to fill the prescription, how they're going to, you know, lay out their medications for the week, how they're going to make sure they maintain their motivation to take it or communicate changes that they need with their medications. When it comes to treatment adherence, you know, we assign individuals journaling to do for example, but I don't know about you guys and how often we assign tasks to to patients to do in between sessions, it's extremely hit or miss. And then you end up spending your next session processing, why they didn't do it when you'd rather be processing what they did. And so it's not to say it's 100%. But a specialist can really help with complementing services in those ways. I think ideally, we know that there's attrition, oftentimes with this population. So here's how we keep people engaged in care. I think the other thing is we think about completing goals or completing treatment plans. But that's not really the case. Again, it's not like that broken leg where your leg gets mended, and you don't have to really do anything afterwards, you have to maintain those gains for the long term to allow you then to get to those next levels of functioning, or satisfaction or fulfillment, whatever they might be. And that's where the period specialists can help somebody in the sort of aftercare discharge planning or even long, long term support through their maintenance of their goals. Katie Vernoy 40:56 I think another element for the treatment team, and this is something where, you know, we had the conversation with Kemisha about this, but they're also an expert on the lived experience. I mean, obviously, each person's experience is different. But there's so much that I think my treatment teams anyway, we're learning from our peers, because they just hadn't been in the situation themselves. And so I think there's, there's also incorporating in that way, like here is another member of the team who has really valuable and valid feedback that you need provider. Because I think it's I think it's hard, I think it's hard to understand this. And I think that we've hidden behind a hierarchy that clearly doesn't work, we need to have, we need to have a whole bunch of human beings working on this on a level playing field. Jeff Kashou 41:47 Yeah, I'm really glad you brought that point up, Katie, I remember, and you guys probably had to do this in your grad programs as well, where we were assigned the task of attending a 12 step meeting to understand what the recovery community is like. And we can see what these you know, non therapeutic support systems are like, and it's a way to get that experience. But we were only assigned that at one point in time, and there is so much value that appear can add in terms of to use your your point expertise in these areas, you know, the approach, I think a lot of us take in the recovery systems, you know, I will get asked oftentimes, you know, well, are you in recovery yourself? And I think as a therapist, you make your own call in terms of self disclosure. And I would say the while I can tell you yes or no, it's more important for you to tell me what your experience is like, rather than me telling you all about what your experience is like. But I think there's a way we can sort of fast track that by having peer specialists add that level of detail to us upfront so that we're not always taxing individuals to have to educate us each and every time if that's not something that supports their care in the short term. Katie Vernoy 42:52 Exactly. Curt Widhalm 42:54 There seems to be a lot of mixed evidence on the effectiveness of pure counselor type programs, with the United States in particular lagging behind a lot of other countries when it comes to the implementation of this, some of which is highlighted by some of the funding stuff that you're talking about within things like Medicaid, and we even see some of this going on and private insurance type programs where this stuff can't be implemented. What do you see is the difference between a successful incorporation of pure counsellors versus the ones that kind of fizzle out, Jeff Kashou 43:32 it's going about it with a systematic approach. And that's I'd really emphasize either, you know, utilizing one of those toolkits, like I mentioned, the city of Philadelphia created, which is extremely comprehensive, and very much focused on the existing org and not necessarily on what peers need to be doing. But I think in the absence of that, it's really identifying just like with any big change that you want to make for a business, it's identifying, you know, what, you know, doing your SWOT analysis, and then looking at what is your measure? What's your success metric going to be? And how will you know you got there and then be flexible, to iterate and improve upon things as you move forward? Again, to that authenticity point, it's just like how we work with our, you know, our clientele, it's, you know, we don't expect perfect, but, you know, let's talk about what didn't go well, and let's improve upon it, we need to be able to do that authentically, as well. I think, unfortunately, in healthcare, and especially behavioral health care systems, where we're kind of the afterthought in terms of funding and attention and resources, you know, we just have always learned to make do and stay the course. And then on top of it, you have folks in power, who don't necessarily understand what we do, and they just kind of keep adding more and more stipulations and regulations and so on. And so it's also a matter of like, can you cut through some of that maybe sometimes even through the side door, like in California, we have our mhsaa funding that peer programs are oftentimes Funded there, which is very nice, and that they don't have to be capturing revenue through Medi Cal. This is through funding that has less requirements to it. But it's also pushing back and saying, do they really need to do this level of documentation? You know, so I do think it's a matter of like, thinking things through from bottom to top, like doing that assessment and really assessing yourself like, can we take this on, and being very brutally honest with yourself as a system of care, it's an exciting program, it's an exciting idea. It's one that can bring a lot of benefit. But you have to really understand what it is that you're bringing on. There's other companies that I've worked for that have said, you know, hey, we're, you know, one day down the line, we'll have peers and that way our current clientele can engage and give back, it'll be kind of a lower level service line. I think if you're thinking about it from that perspective, only, and really seeing the dollar signs as part of that image. It's not to say that, you know, money isn't the driver here, but it can't be that upfront. Otherwise, what you're doing is you're commoditizing, a service provider who is designed really to add value simply by them being there and engaging with clientele in that way, without necessarily generating dollars by increasing retention by increasing engagement in services. We know outcomes improve, when systems can demonstrate improve outcomes. Oftentimes, they're the ones that get the next grant are the ones that get the renewed contract, sometimes even a larger contract. So it's really, you know, credenza question in a short way. It's, it's all about approaching it systematically. And not just Yeah, that sounds really exciting. Let's do this. Katie Vernoy 46:43 I think it has to be baked in, it can't be like, let's add this on to the program. It's almost like you have to build it from the ground up, to have these truly integrated into whatever the treatment program is. Jeff Kashou 46:56 Yeah, there's kind of three different approaches that that Philadelphia tool toolbox outlines, just like that additive approach that I discussed, there's that selective approach. And then it's really taking on the one that has the greatest level of success is what's called a transformative approach, which a lot of systems are understandably nervous to take on. But to make a program successful, you have to be willing to transform things, sometimes top to bottom to make it work. Katie Vernoy 47:21 Yeah, it's interesting, because the the program that I had, it was, it was baked in, it was like, my agency decided to do a wraparound program. And at the time, it was called an FSP. Program. And so as, you know, maybe you move clinicians into it, but it was like, here is how you do it. And it was baked in. So it wasn't like, Oh, you're already doing services, let's add this on. Functionally, maybe it looked that way. Because we had clients who then you know, like, followed their therapist, and then got these other services added on. But the program itself was well defined by LA County. And so there was discrete roles, there was training that was required. And like, especially with wraparound, there was like, a week long training where you, everybody went, and there were people from all different roles, and you went when you just first started and all the managers had to go to, so I had to go to it as well. And we would sit there for a full week and interact with other people in our same roles or in the in the peer or the you know, the all the different specialists roles. And so to me, it was, it didn't feel as chaotic because it was like it was completely structured. And it was baked in. Jeff Kashou 48:31 Yeah, and a wraparound program is oftentimes very much set up for that, you know, they traditionally will have either bachelor's level providers as PSCs, or personal service coordinators, which truthfully appear would be phenomenal at which it sounds like that was the role that you had at your program. And because Katie Vernoy 48:47 No we had we had bachelor's level folks, we had peers, we had a facilitator, and we had a therapist, so there was four or five people on the team. Jeff Kashou 48:56 That's a tremendous program. You know, and we're the approach, you know, you've probably experienced this as well, the approach of a wraparound program is like whatever it takes, you know, this is a child, an individual, a family in such a challenging situation that we have to throw everything at this person that they need, and and some to get them to the, you know, to a better place. Katie Vernoy 49:17 Yeah, yeah. I think it just is a good way to think about it as if you actually create a program from the ground up that includes these roles. I think that is stronger. I'm really glad that we're that we did this episode that we're talking about this related to our fixing mental health care in America. I know that it was mentioned in the RAND report, but I also recognize that one of the elements of this is it has been viewed. I think we did this in one of our more recent advocacy and workforce episodes as a way that we take away work from licensed credentialed mental health professionals and I really see this as an important adjunct a positive step forward. And I think we were able to really see that in the conversations that we had with our three guests today. Curt Widhalm 50:08 And I mentioned a couple of times in the show, both this episode and recently about how little using supporting roles, like peer support specialists is actually taught as part of therapists education. Katie Vernoy 50:22 Yeah. Curt Widhalm 50:23 And there's a lot of emphasis on therapists education that's on what we as individuals can do to help with clients, but don't help us to look at the overall workforce system. And I'm echoing your happiness of this episode. And being able to amplify that really good. Mental, behavioral, emotional health treatments, takes a village. And it does take people from a lot of different viewpoints to really help create healing. And especially those people who have that lived experience and have a really great way of helping to help our clients interact with the system to be able to navigate it in ways that makes sense for them. So continuing to emphasize this will be part of our ongoing role in bringing mental health advocacy to the world. And we encourage you to do so as well. Katie Vernoy 51:24 And for folks who were really interested in this, there are a lot of links in the shownotes that will help you with some of the some of these concepts, we've got the the guides and those things both onpattro and Jeff sent stuff over that are very helpful for folks who either want to be a peer support specialist or who want to implement those programs. So definitely feel free to reach out to us if can't find it on our show notes. But those things are just the really amazing resources that we were able to put down there. Curt Widhalm 51:55 You can find those show notes over at MCSG podcast.com. And check out our social media out give us a like or a follow and schrinner Facebook group modern therapist group to further these discussions. And until next time, I'm Kurt Wilhelm with Katie Vernoy. Katie Vernoy 52:11 Thanks again to our sponsor, trauma therapist network. Curt Widhalm 52:15 If you've ever looked for a trauma therapist, you know it can be hard to discern who knows what and whether or not they're the right fit for you. There's so many types of trauma and so many different ways to heal. That's why Laura Reagan LCSW WC created trauma therapist network. Trauma therapist network therapist profiles include the types of traumas specialized in population served therapy methods used, making it easier for potential clients to find the right therapist who can help them. Network is more than a directory though its community. All members are invited to attend community meetings to connect consults, and network with colleagues around the country. Katie Vernoy 52:52 Join the growing community of trauma therapists and get 20% off your first month using the promo code Mt. 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This episode is brought to you by the Blue Cross Blue Shield Association. Blue Cross and Blue Shield companies are in every ZIP code in every state, working to improve health and expand access to care. Community by community. For the health of America. I'm joined today by the top leadership of Seniorlink, an innovative company that provides coaching, emotional and financial support for families caring for loved ones. Tom Riley serves as CEO, and Matt Marek is the President and Chief Operating Officer. Together, they are working with Medicaid-eligible and Medicare Advantage members who want an alternative to nursing home care. Seniorlink supports and provides the needed tools to the millions of family caregivers who are key to keeping their loved ones healthy and cared for in the home setting. With November being National Family Caregivers Month, our discussion today is both timely and needed.
How can someone talk non stop for over 8 hours-- House Minority Republican Leader McCarthy did. What did he prattle on about? Don't worry, I've got the 2 minute lowdown. I've got some highlights of what's in the bill including a new $5000 refundable credit for electric vehicles.. what does refundable mean? Not only that, but remember the 12 states that never expanded Medicaid to cover the poor? Those folks are finally going to get some insurance! #BuildBackBetter #ForThePeople #McCarthy
Sadé Dozan of Caring Across Generations discusses the Build Back Better bill, which would put some $150 billion into Medicaid-supported homecare services. The post Belabored: Our Neglected Human Infrastructure, with Sadé Dozan appeared first on Dissent Magazine.
In the second episode of "Industry Voices", we talk to a range of healthcare changemakers encountered at HLTH in Boston last month about health equity. Is the industry's attitude toward this important topic changing? Is it changing fast enough? And what steps and attitudes will be necessary to make the future of healthcare an inherently equitable one?This episode features the voices of Cityblock Health President Toyin Ajayi, UC Davis Chief Information and Digital Health Officer Ashish Atreja, Digital Medicine Society CEO Jennifer Goldsack, Deloitte Partner Peter Micca, and Uber Global Head of Health Caitlin Donovan.More about this episode:Cityblock rakes in $400M for platform focused on Medicaid and low-income populations and other digital health fundingsModernizing Medicare and Medicaid means addressing the affordability crisisDeloitte's Gebreyes: 'Health equity is a moral imperative that requires a business solution'Leveraging technology to achieve health equityAddressing health inequities upstream can curb later health disparitiesHealth equity, SDOH key priorities for ONC, says deputy national coordinatorHealth IT and racial justice: Expanding access, ending disparities, empowering communities (Healthcare IT News Special Collection)HFMA's first Black chair tells finance leaders to focus on diversity, inclusion and health equity
In this healthcare podcast, I speak with Peter Hayes, who is president and CEO at the Healthcare Purchaser Alliance of Maine and a national presence in healthcare strategy, innovation, and a frequent keynote speaker. One thing, among many, that Peter said during our conversation struck me. He said it will take a village to fix what ails the healthcare industry in this country. There are too many interdependencies. This point obviously resonates around these parts because it's the rationale for the Relentless Health Value podcast. We started this show on the recognition that if you want to achieve anything in healthcare, you cannot do it without collaboration/cooperation/grudging acquiescence of other stakeholders in the patient journey or the payment journey. And when I say, “You can't do anything,” I mean you can't sell anything, you can't improve patient care, and, most relevant to this particular episode, you can't contain prices. If we're talking about health systems (for example, hospitals and the like), they are not going to curtail their price hikes or improve the value of care delivered or safety or infection control really unless patients and employers and CMS and others demand that they do—and unless employers and others do some of the five things that Peter Hayes mentions at the end of our conversation. Spoiler alert there. For context to this discussion, let's check in with some of the biggest, most powerful health systems in this country. If I limit this comment to the “nonprofit” ones—and I say “nonprofit” with air quotes because what does that mean exactly?—look, I know there are many health system execs that listen to this show, but there's some inalienable facts here. And let's talk about them with the intent of fixing them because nothing is going to get fixed that isn't talked about. It's not my nature to mince words, so I won't. Many hospitals are, by almost every account, pretty darn inefficient. And they don't do cost accounting, but then they'll scream and claim to be losing money when paid the exact same prices for certain services that other hospitals can get paid and make a fair profit. Crappy workflows cost money. Talk to anybody who has watched even the trailer to a Six Sigma course. Another thing that costs money is when all the burned-out doctors quit and you have to recruit new ones, but that's a topic for a different day. Listen the EP323 with Arshad Rahim, MD. But there's also inefficiencies in how many health systems purchase supplies. (Listen to EP281 with Rob Austin for more on that.) Further, paying the C-suite millions of dollars but maybe underpaying or understaffing nurses has consequences. There's complaints about Medicare payer mixes, but then somehow there's enough spare shekel to put a waterfall in the lobby. Nonprofit hospitals also don't pay any taxes, keep in mind, which is a huge financial windfall, especially when they provide vanishingly small amounts of charity care compared to revenue. See the top 10 health system hall of shame in this category here. Here's another point to ponder: Amongst the hundreds, thousands, of requests I get from PR firms pitching guests to come on this show, there are plenty from what appears to be a pretty large cottage industry that I had never heard of before. I'll call it the real estate for nonprofit hospitals cottage industry. From what I can gather by the promo copy, this involves buying up medical office buildings, not paying any real estate taxes, and then leasing out the space. I should have one of these guys come on the show just to shine some light on whatever this apparently pretty common shenanigan is. As Vikas Saini, MD, from the Lown Institute has said, “No margin, no mission” can become an excuse for all kinds of questionable behavior. So bottom line, we have employers, employees, taxpayers, cash-pay patients whose federal and/or state and/or local taxes are going to support these nonprofit hospitals—but then there's this double tax. Because they claim to be losing money on Medicare patients, they justify cost shifting some pretty big bucks onto the commercially insured patients, who are then paying, on average, some wildly inflated prices for healthcare services. This might be considered a double tax if you think about it: tax dollars going to the IRS directly and then after-tax dollars buying that knee replacement for $125,000 that should cost $25,000. Consider that a $100,000 double tax. But why should a hospital with a motive to maximize margins quit it with their questionable and secretive billing practices if employers just pay whatever the bill is no fuss no muss? Short answer: They won't. So, it's going to be up to someone else in the village to make it untenable to continue. It's going to be up to another party to slow that roll. In this conversation, Peter Hayes talks about the RAND Hospital Price Transparency Study. One last thing that may or may not be relevant here, but I can't resist a good sidebar. New catchphrase I have been hearing lately: the “deconstruction of hospitals.” Have you heard it, too? In fact, I was listening to Zeev Neuwirth's podcast recently that featured Raphael Rakowski. Raphael said that the average fixed cost of any given brick-and-mortar hospital is 65% of revenue. So, just having the building, the physical plant, and paying for all the things you need to pay for to run that physical plant is really high. I heard Jason Wells say in a HealthIMPACT forum the other day that it costs a million dollars to build a bed in California due to all the regulatory requirements. Add to that something Christin Deacon highlighted the other day on LinkedIn about how operating rooms are empty 30% of the time. So, it makes me wonder whether some of the issues that hospitals have when they claim that they are losing money on Medicaid or Medicare is because their fixed costs are out of whack. This potentially disproportionate situation, however, is one reason why hospitals really have to watch it for hospitals at home or virtual offerings. After all, this is exactly how Amazon ate everybody's lunch. Erase 65% of your costs, or even 50% of your costs, and that cost-plus profit threshold becomes a weapon of mass destruction. At the end of this podcast—the very end, so if you're in a rush, jump to 28 minutes or something [32:45]—Peter gives five ideas for employers to limit the ability for hospitals to take advantage. If you're a hospital exec that's listening, I would urge you to please help your local employers do these things. Let's all get on the same team here to improve the health of our communities with pricing and business models that are reasonable and fair. Don't be like the hospital that Katy Talento is going to talk about in an upcoming episode who won't do direct contracting with employers because the coding is kind of a hassle. Seriously now. You can learn more at purchaseralliance.org. Peter Hayes is president and CEO of the Healthcare Purchaser Alliance of Maine and formerly a principal of Healthcare Solutions and director of associate health and wellness at Hannaford Supermarkets. He has been in innovative, strategic benefit design for the past 20+ years. During the past several years, Hannaford has received numerous national awards in recognition of the company's commitment to working collaboratively with healthcare providers and vendors in delivering health benefits that are focused on value (high-quality efficient care). Hannaford Supermarkets has been successful in this arena by focusing on innovative solutions for patient advocacy, chronic disease management, and health promotion programs. Hannaford was recognized by receiving the National Business Group on Health Platinum Award for the health promotion and wellness programs three years in a row. These programs, along with healthcare delivery strategies, contributed to a flat trend line over five years. Peter has also been involved in healthcare reform leadership roles on both the national and regional levels with organizations like the Center for Health Innovation, Care Focused Purchasing, and Leapfrog. He's also cofounder of the Maine Health Management Coalition (now Healthcare Purchaser Alliance of Maine) and has been appointed by two different Maine Governors to serve on Health Care Reform Commissions to recommend public policies to improve the access and affordability of healthcare for Maine citizens. 07:51 Who are the commercial payers? 08:48 Are hospitals actually losing money on Medicare and Medicaid? 11:26 Is cost inversely connected to quality when it comes to hospital care? 13:46 “A lot of hospitals don't do cost accounting.” 13:59 If hospitals don't know their costs, how does Medicare know their costs? 15:52 “In the hospital financial world … they start the budget upside down.” 18:48 “There's plenty of accountability to spread around for where we are.” 20:30 Do employers have any options in the current health system situation? 21:39 “If this market's going to change, purchasers have to step up and start demanding more accountability, more transparency.” 26:21 How is the new transparency legislation impacting plan sponsors and employers? 29:41 EP342 with Christin Deacon.32:38 “I think the whole dialogue around how we pay for hospital services is going to really change.” 32:45 What is Peter's advice to employers? You can learn more at purchaseralliance.org. @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth Who are the commercial payers? @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth Are hospitals actually losing money on Medicare and Medicaid? @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth Is cost inversely connected to quality when it comes to hospital care? @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth “A lot of hospitals don't do cost accounting.” @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth If hospitals don't know their costs, how does Medicare know their costs? @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth “In the hospital financial world … they start the budget upside down.” @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth “There's plenty of accountability to spread around for where we are.” @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth Do employers have any options in the current health system situation? @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth “If this market's going to change, purchasers have to step up and start demanding more accountability, more transparency.” @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth How is the new transparency legislation impacting plan sponsors and employers? @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth “I think the whole dialogue around how we pay for hospital services is going to really change.” @pefhayes of @HPAofMaine discusses #healthsystempricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth Recent past interviews: Click a guest's name for their latest RHV episode! Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim
In this special minisode, Jen sits down with Healthcare Industry Advisor Mindy McGrath to discuss the public health trends she sees being most impactful in 2022, including: expanding access (01:15), addressing affordability (02:30), amplifying value (03:34), increasing interoperability & data sharing (04:42), and bolstering government payer solvency (05:30). Podcast Tags: healthcare, public health, healthcare trends, access, affordability, Medicare, Medicaid, data For additional discussion, please contact us at TrendingHealth.com or share a voicemail at 1-888-VYNAMIC. Mindy McGrath, Healthcare Industry Advisor mindy.mcgrath@vynamic.comJen Burke, Healthcare Industry Strategistjen.burke@vynamic.com
If you are one of those people who run to the clinic to see a doctor for any little ailment, or just to get endless check ups to make sure you are all right; well, you are doing it all wrong my friend! No offense, but medical interventions are usually the cause of more harm than good.Iatrogenesis is the term that defines this: it means death by doctor. This means that the treatment or examination you undergo causes harm. Hippocrates, the founder of Western medicine from 2500 years ago in Greece, had as his fundamental tenet to early healers to first, do no harm! In modern times, this prime directive has been discarded…Death by doctor is now the third leading cause of death! Now, does this make you want to visit your doctor more often? I certainly hope not: I would advise you to live as people used to live until around the 1970's in the US at least. Back in the 50's and 60's, when I grew up, we only went to the doctor if we were gravely injured or on our deathbed from a real sickness. Doctors could do things like set broken bones, or remove a ruptured appendix, or take a bullet out of your body. They were like human bodywork mechanics, similar to their car repair similar types of workers. Nothing fancy, they just tried to get the job done.Now though? Doctors and hospitals, which throughout time were places to avoid as much as possible, are now depicted as places to go to become and remain healthy. We are all urged endlessly to go in, get examined (even if we feel great), and to search for ways to be ‘improved' by medical interventions: drugs and surgeries; endless drugs and surgeries!It is never mentioned that drugs, and surgeries- all have side effects. Endless side effects, that are often far worse than the imagined ‘conditions' we are told we have! It has reached the point where, if you go in to get ‘checked out', based upon only your age, say: they will prescribe all kinds of drugs to you! (With all kinds of side effects that treat your supposed ‘conditions' that the doctor has found within you.You have to ask yourself this- do humans need drugs and surgeries to survive? If this were true, we would have died out long ago- our grandparents never had this stuff done to them, and they lived long and happy lives, generally. Childbirth was very dangerous in the old days, for both mother and child, and that has been largely solved. Mainly by early discoveries of sanitation like washing hands between autopsies and deliveries, things like that…But overall, our health since the 1970's or so has steadily worsened. The medical recommendations of low fat, high carb and sugar along with limited red meat has resulted in epidemics of heart disease and cancer, along with a skyrocketing of diabetes!This is largely because we now have a health care system that is government regulated, and financed as well via employer insurance along with Medicare and Medicaid. Because we the public perceive that now we no longer have to pay for it- why, we will go to the doctor all the time! It's free, after all. So, the health care costs go up and up and up, far beyond what a normal person could really pay- but we don't care. It's “free”! We agree to any shot or procedure, and surgery or bodily mutilation and especially to free drugs. Drugs that mess with our minds and bodies beyond what anyone could have ever imagined just a few decades ago…All of this has even become political- the Leftist Democrat party of Big Government running everything has destroyed our collective health in a huge way, and now recommend massive injecti
The Centers for Medicare & Medicaid Services (CMS) issued an interim final rule outlining vaccine requirements for staff at Medicare- and Medicaid-certified providers and suppliers. Attorney Frank Morris discusses the next steps for health care providers. In addition, covered employers should continue to monitor the recent litigation filed in the Eastern District of Missouri and the Western District of Louisiana seeking to permanently enjoin the CMS interim final rule. Visit our site for this week's Other Highlights and links: https://www.ebglaw.com/eltw234tr2. Subscribe to #WorkforceWednesday - https://www.ebglaw.com/subscribe/. Visit http://www.EmploymentLawThisWeek.com. The EMPLOYMENT LAW THIS WEEK® and DIAGNOSING HEALTH CARE podcasts are presented by Epstein Becker & Green, P.C. All rights are reserved. This audio recording includes information about legal issues and legal developments. Such materials are for informational purposes only and may not reflect the most current legal developments. These informational materials are not intended, and should not be taken, as legal advice on any particular set of facts or circumstances, and these materials are not a substitute for the advice of competent counsel. The content reflects the personal views and opinions of the participants. No attorney-client relationship has been created by this audio recording. This audio recording may be considered attorney advertising in some jurisdictions under the applicable law and ethical rules. The determination of the need for legal services and the choice of a lawyer are extremely important decisions and should not be based solely upon advertisements or self-proclaimed expertise. No representation is made that the quality of the legal services to be performed is greater than the quality of legal services performed by other lawyers.
One hundred years ago in November, two Canadian researchers at the University of Toronto, Frederick Banting and Charles Best, discovered insulin, the life-saving drug for people with diabetes. What was once a death sentence is today a manageable condition with a tubeless insulin pump, and potentially oral insulin not far down the road. The rate of diagnosis of type 1 and type 2 diabetes has surged among the U.S. youth population between 2001 and 2017. Data published Aug. 2021 shows a 45% increase in the number of children and youth under age 20 living with type 1 diabetes, while the number of children and youth living with type 2 diabetes climbed by 95%. The Juvenile Diabetes Research Foundation (JDRF) points to studies that estimate five million people in the U.S. to have T1D by 2050, including nearly 600,000 youth. But racial, ethnic, and socioeconomic disparities in blood-glucose outcomes among ethnic and racial minorities exist, as reported in the Type 1 Diabetes Exchange (T1DX) Research Registry and SEARCH study cohorts. In Connecticut, Medicaid covered 1156 children and youth below age 20 for type 1 diabetes in 2021, and 928 for type 2 diabetes, per the latest data. The HUSKY Health / Medicaid program covered 408,082 children and youth below the age of 20 for 2021, year to date. In this hour on Where We Live, we discuss trends, technologies, disparities, access, and outcomes. GUESTS: Marie Snow: Public school teacher in Guilford. Mother of Olive, diagnosed with type 1 diabetes Olive: Diagnosed at age 9 with type 1 diabetes Dr. Jennifer Sherr: Pediatric Diabetes Specialist at Yale Medicine, and Associate Professor of Pediatrics (Endocrinology) at the Yale School of Medicine Jon Muskrat: Executive Director, Juvenile Diabetes Research Foundation (Connecticut and Western Massachusetts Chapter) Mark Abraham: Executive Director, DataHaven Support the show: http://wnpr.org/donate See omnystudio.com/listener for privacy information.
Presentado por nuestros patroncitos y patroncitas PYMES: Armería Gutierrez en Arecibo, tu armería (y club de tiro) patroncito. Haz los trámites para tu portación de armas o practica tu puntería en Arecibo. Búscalos en Facebook o llama al 787-878-8329. PATRONCITOS ORIGINALES, la Armería Gutierrez en Arecibo. --- Los jabones Don Gato son hechos a mano, sin químicos dañinos ni detergentes. Elaborados con los mejores aceites naturales, esenciales y aromàticos, seguros para la piel. Pruébalos y siente la diferencia. Visítalos ahora en jaboneradongato.com y con la compra de 4 barras o más te llevas gratis una jabonera de madera, además al utilizar el código "ppp" obtienes un 10% de descuento en tu compra. Sígelos en sus redes face book, instagram y twitter como jaboneradongato para mantenerte informado. --- TaxLeg LLC servicios de asesoria en Recursos Humanos y Asesoria Legal y contributiva y tramite de Exencion Contributiva bajo la nueva Ley de Incentivos Contributivos. Lcda Ivellisse Quinones Tel- 787-313-2323 y 787-943-8095 email - quinonesocasiolaw@gmail.com -- El fisiatra “PPP” Ruben Rivera con especialidad en medicine deportiva ubicado en Caguas y Humacao. Atendemos lesiones deportivas, dolor de espalda, artritis, síndrome de túnel carpal, rehabilitación ortopédica post operatoria. Realizamos estudios electrodiagnosticos (“estudio de agujas”), inyecciones de tendones, articulaciones como rodilla, hombro y cadera guiadas por sonografía e inyecciones de plasma rico en plaquetas (PRP). Para citas se puede comunicar al 787-745-4355 en Caguas y al 787-850-7393 en Humacao. --- En este PPP Extra tocamos lo último sobre la nueva pugna dentro del PPD. También, los efectos de la opinión del GAO sobre los fondos del Medicaid para Puerto Rico y la carta de María de Lourdes y KuVaH. Suscríbete a nuestro Patreon y recibe contenido exclusivo, artículos: https://patreon.com/puestospalproblema See omnystudio.com/listener for privacy information.
The Omnibus COVID-19 Health Care Staff Vaccination Mandates are out! What entities are included under the regulations, and which are excluded?Facilities and physician practices have been doing everything they can to get staff and providers vaccinated, in fear of losing their provider status with Medicare and their funds being interrupted. But what organizations really must abide by these requirements under the Centers for Medicare & Medicaid Services (CMS) Conditions of Participation (CoPs)? Hospitals? Physician Offices? Skilled nursing facilites (SNFs)? Home health agencies? Assisted living facilities?To highlight the correct information on where your organization stands and the impact it will have, please join us for the next edition of Talk Ten Tuesdays on Nov. 16, during which nationally recognized physician coder, auditor, and educator Terry Fletcher will update us on all this and more. The live broadcast will also feature these other segments:Mental Health Report: Internationally renowned psychiatrist and author Dr. H. Steven Moffic will return to the broadcast to report on workplace burnout – especially in the healthcare workplace, and in particular among caregivers, in the light of new final rules from the Centers for Medicare & Medicaid Services (CMS). The Coding Report: Laurie Johnson will report on the latest coding news that has appeared on her radar screen. News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc., and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.
Only 90-minutes after his official announcement that he'd be running for Texas Governor, Democrat Beto O'Rourke joined the Jasons for this early episode of Y'all-itics. And one of the first things they noticed was a different candidate than in the past. O'Rourke didn't hold back, speaking directly about many issues, including his past comments on guns, February's power grid fiasco, protecting oil & gas jobs, even trying to lower property taxes through Medicaid expansion. The Jasons also get more perspective on O'Rourke's candidacy and the gubernatorial race from the journalist who broke the news that Beto was back… and running for Governor.
Temas de hoy: Preocupación por el alza en los contagios ¿Se propone Pierluisi botar al Secretario Interino de Educación, Eliezer Ramos? Hora cero en la disputa entre la Cámara y LUMA Contra el reloj la legislación federal que beneficiaría a PR, incluyendo Medicaid, SSI e incentivos Aunque las diferencias son limitadas, no hay consenso para aprobar las enmiendas a la reforma laboral Converso con Julio Billoch de Gramas Lindas, en el barrio Magüayo en Dorado – 787-796-1386 See omnystudio.com/listener for privacy information.
This is the Everything Medicare Podcast hosted by Christian Brindle. It can be found on most major platforms that podcasts can be found. Christian Brindle was raised & brought up around the insurance industry. With his dad being an insurance broker for close to 30 years, Christian had the luxury of being able to learn all about the industry from a young age. Christian has worked with people far and wide on their Medicare plans and has seen close to any situation. Christian believes in empowering people on Medicare by not just finding them a plan, but showing them and educating them on why that plan is a good fit. Christian hosts the most popular Medicare podcast on the internet called The Everything Medicare Podcast, written and published two books about Medicare, and is the founder of his own company that is dedicated to helping people on Medicare everywhere. Don't forget to like and subscribe for more videos! Helping people in Utah, Idaho, Colorado, Washington, Oregon, California, Texas, Virginia, West Virginia, South Carolina, North Carolina, Alabama, Florida, Arizona, Nevada, Alaska, Mississippi, Kentucky, Arkansas, Illinois, Kansas, Nebraska, Maryland, Georgia, Tennessee, Missouri, Indiana, Louisiana, Pennsylvania, Maine, Michigan, Wisconsin. Visit our website for more information: www.christianbrindleinsuranceservices.com Pick up Christian's Medicare Guidance book and learn everything you need to know to make a good choice: https://www.amazon.com/Medicare-Guida... Follow us on social! Facebook: https://www.facebook.com/christianbri... Instagram: https://www.instagram.com/christianbr... Twitter: https://twitter.com/C_E_Brindle #Medicare #Medigap #Insurance #HealthInsurance #Health #Healthcare #Medicaresupplement #MedicareAdvantage #Medicare2021 #Medicarehealthplan #InsuranceAgent #MedicarePodcast Medicare, Medigap, Medicare Supplement, Insurance, Health Insurance, Health, Healthcare, HAS, Retire, Retirement, Social Security, Christian Brindle, FICA, Medicare Podcast, Medicare Advantage, Medicaid, Medicare Part A, Medicare Part B, FICA, FICA Tax, Retirement, Retire
The Rockefeller Foundation releases its 5th survey of Americans' attitudes about the pandemic response; Dr. Nicole Alexander Scott, Director of the Rhode Island Department of Health, says every public health agency should update its Healthy People 2030 plan to reflect the pandemic's impact on measurable goals; ASTHO and the Center for Health Care Strategies offer a report explaining how public health departments can partner with Medicaid to advance health equity goals; and ASTHO's Maggie Davis shares her “thankful note” in advance of Public Health Thank You Day on November 22nd. The Rockefeller Foundation website: COVID Complications – Insights and Guidance on Ongoing Pandemic Communication Healthy People 2030 webpage: ODPHP's COVID-19 Custom List Center for Health Care Strategies webpage: Cross-Agency Partnerships for Health Equity – Understanding Opportunities Across Medicaid and Public Health Agencies APHA webpage: Public Health Thank You Day
Plaintiff attorneys often ask us what the options are for clients to maintain needs-based government benefits after receiving a settlement. In this episode, Greg Maxwell outlines the four main options available to clients on needs-based benefits, discusses the differences between them, and when each of the options may make sense for the client. Contact Greg Maxwell at (801) 683-7362 or at Maxwell@AmicusPlanners.com if you have any questions about this podcast episode. — Join the Personal Injury Attorney Facebook Group — Join our Facebook group to connect with attorneys nationwide and learn how to grow, improve, and streamline your practice. Click here to join: https://amicus.llc/Attorney-Group — YouTube Content — To view our Settlement Planning Quick Tip series, visit: https://amicus.llc/QuickTip You can subscribe to the Amicus Settlement Planners YouTube channel by clicking here: https://amicus.llc/You-Tube — Contact Amicus — Website: https://www.AmicusPlanners.com/ Email: Contact@AmicusPlanners.com Phone: (801) 683-7362 — Follow us on Social Media — Twitter: https://amicus.llc/Amicus-Twitter Facebook: https://amicus.llc/FB-Page YouTube: https://amicus.llc/You-Tube LinkedIn: https://amicus.llc/Linked-In — Blog Content — To read our latest articles and see our latest settlement-related content, visit the Amicus Settlement Planners blog: https://amicus.llc/Articles
More and more consumers can use their health insurance to buy fresh produce online and have it delivered to their homes, and now those who qualify can supplement that by using their SNAP/EBT cards online. The U.S. Department of Agriculture approved Farmbox Direct's healthcare initiative, FarmboxRx, to offer its fresh produce delivery nationwide to people whose health insurance, including Medicare and Medicaid plans, have this food benefit as part of the plan. That includes the Over the Counter, or OTC Network. Read more: Health insurance, SNAP benefits can pay for produce online via FarmboxRx See omnystudio.com/listener for privacy information.
This week, we've got a healthy batch of self-promotion and an amazing legislative guest. C'mon now, that's what we're best at! First, Yaël rides solo and gives some updates on the two COP events: COP26 on climate change and COP9 that could change laws on vaping! Then it's all about inflation and how we crypto will solve many of these issues. INTERVIEW: U.S. Rep. Larry Bucshon (R-Indiana) joins Consumer Choice Radio to discuss infrastructure spending, vaccine mandates, plastic bans, healthcare costs, and how we can improve our healthcare system. (full video here) The Biden Infrastructure Plan is not ready for primetime A doctor's thoughts on why the federal vaccine mandate isn't helpful Government mandates will harm workforce numbers The utility of man-made chemicals (PFAS) and why we should use science to evaluate which to regulate and ban Democrats often don't want amendments added to their bills Increasing healthcare transparency and consumers wanting free markets to drive down prices The folly of allowing healthcare insurance to drive prices up. We need more competition and consumer choice Reimbursement cuts for Medicare and Medicaid, and the debt limit. We don't fund the government correctly Then in our third segment, we play the audio from David Clement's testimony at the New York State Assembly on the dealer franchise laws that make it harder for consumers to buy electric vehicles. Full video here. Broadcast on Consumer Choice Radio on November 13, 2021. Syndicated on Sauga 960AM and Big Talker 106.7FM. Website: https://consumerchoiceradio.com ***PODCAST*** Podcast Index: https://bit.ly/3EJSIs3 Apple: http://apple.co/2G7avA8 Spotify: http://spoti.fi/3iXIKIS Our podcast is now Podcasting 2.0 compliant! Listen to the show using a #Bitcoin lightning wallet-enabled podcasting app (Breeze, Fountain, etc.) to directly donate to the show using the Bitcoin lightning network (stream those sats!). More information on that here: https://podcastindex.org/apps Produced by the Consumer Choice Center. Music by the great Richard Durana and Space Recorder: https://open.spotify.com/artist/1QBalIH9bK3h7ZQYFrca3Z https://open.spotify.com/artist/7F31I25SJCNKinlvJj8Iu1 Support us: http://consumerchoicecenter.org/donate See omnystudio.com/listener for privacy information.
In the first month since Missouri started processing Medicaid expansion applications, some 13-thousand people have enrolled in the service. That has major implications for Missourians dealing with cancer, which requires expensive treatment and benefits from early detection.
A BIG thank you to all the veterans who secured our freedoms through their service. Their sacrifices are noted, especially those who gave their lives. Matt Albright, Director of Center for American Values based in Pueblo, is Kim's guest on America's Veteran's Stories this Sunday, 3pm on KLZ 560 AM and KLZ 100.7 FM. The “Brandon” administration acts in complete contrast to Trump's as the Biden administration double downs on anti-American ideals, forced mandates such as no jab-no job, increased regulations and high taxes. Kim, on Veteran's Day, appropriately reflects on her experience in Normandy, France for the 73rd anniversary of the WWII D-Day landings. Frequent guest Dr. Jill Vecchio joins Kim to discuss the COVID-19/Wuhan-China Virus narrative. How did healthcare workers go from heroes to zeroes in a year? The government is controlling what doctors can and cannot do. Polis issues an executive order that gives him power to decide who will and will not be admitted into a hospital thereby creating two classifications of patients. The problem at hospitals is not beds but staffing as many healthcare professionals left the industry when Polis mandated that all healthcare workers must take the experimental vaccination. His actions violate the Hippocratic oath of “do no harm.” Risk benefit analysis and informed consent are not part of the mandated vaccination process. Polis' actions makes one question what he will do next. The 10th Amendment to the U.S. Constitution says that powers not delegated to the federal government are reserved to the states or to the people. A true healthcare free market will bring down costs, increase access and improve quality. Governor Polis is setting up two classifications of people: vaccinated and unvaccinated. Epoch Times is the media leader in reporting medical discrimination. Dr. Vecchio walks us through a historical perspective of nationalized healthcare. Karl Max noted that to control the people, government should control healthcare. Medicare and Medicaid began in the 1960's under Johnson's socialized programs. Obamacare was signed in 2010, which strengthened government control of healthcare, and made it more difficult for small medical practices to survive. Many doctors sold their practices to large corporations. Most physicians now practice under large corporations which is destroying the patient-doctor relationship. Doctors must obey the corporation's demands (i.e. vaccine mandates) so that they can continue to practice and make a living. Big business and big government like each other. Big business influences big government PBI's (Politicians, Bureaucrats and Interested Parties) to write regulations that favor the corporations. Corporations write checks to the politicians/candidates. We are witnessing a major transition in the medical industry: caring, ethical and moral individuals are changing his/her standards to comply to mandates and regulations. This leads to vicious behavior, to the point that patients are used as experiments (current vaccinations) and some are killed in the process. We have seen this transition over the past twenty plus months. Dr. Vecchio and Kim state that Americans are strong and are observant. Call your representatives and stand up so your voice will be heard.
Is the emergency department (ED) an outpatient CDI priority for your organization? The emergency department is the main source of admissions to a hospital – and the first location patients typically receive care. What should you consider when determining how an outpatient CDI program could support quality patient care, proper payment, and complete and accurate data? During the next live edition of Talk Ten Tuesdays, outpatient CDI expert Colleen Deighan will return with another installment in her popular series on a subject that continues to generate listener interest and questions. Deighan will also conduct a listener's survey during the weekly Internet radio broadcast.The live broadcast will also feature these other segments:Special Series: Maternal Morbidity and Mortality: Senior healthcare consultant Kristi Pollard, Director of Coding Quality and Education for the Haugen Consulting Group, wraps up her four-part series on the impact of coding on severe maternal morbidity with a discussion about the intersection of coding and clinical indicators. Conditions specifically in the crossfire are sepsis, acute kidney injury, and coagulation disorders. Pollard will address which data the maternal collaboratives want to track and how you can incorporate these initiatives into existing CDI programs. The Coding Report: Laurie Johnson will report on the outcome of the recent ICD-10 Coordination and Maintenance Committee meeting. RegWatch: Stanley Nachimson, former Centers for Medicare & Medicaid Services (CMS) career professional-turned-well-known healthcare IT authority, will report on the most recent final payment rules released by CMS on Tuesday.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc., and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.
Rate & review the Simply Financial Podcast on ITunesSpecial Guest: David Harris, Vice President, Nationwide Retirement Institute, Insights & Solutions Field TeamDavid W. Harris joined Nationwide in 1997. As a Vice President for the Nationwide Retirement Institute, Dave is dedicated to educating financial professionals, clients, plan sponsors and plan participants about the latest in retirement income solutions. He stimulates the thinking and actions of professionals as they navigate the changing world of retirement.Dave annually addresses thousands of financial professionals and participants, and his sessions are carefully customized to meet the needs of each group. Dave's polished style, engaging message and proven ability as a business professional assure top-notch engagement. Dave is a graduate of The Ohio State University, where he majored in Finance. Dave is FINRA Series 26 and 6 licensed and Ohio life and health licensed. His experience includes strategies for retirement income planning, long-term care, Social Security benefits, and Medicare and Medicaid coverages.Throughout his career, he has enjoyed being one of the founding members of the Nationwide Retirement Institute. He has been interviewed by and quoted in the Chicago Tribune and interviewed on Financial Talk Radio about health care costs in retirement. Dave has been ranked a top speaker at national meetings, and he qualified for Nationwide's Sales Rewards Trip each of the six years he was eligible.Dave Harris's Full BioVisit https://www.nationwide.com/
This is the Everything Medicare Podcast hosted by Christian Brindle. It can be found on most major platforms that podcasts can be found. Christian Brindle was raised & brought up around the insurance industry. With his dad being an insurance broker for close to 30 years, Christian had the luxury of being able to learn all about the industry from a young age. Christian has worked with people far and wide on their Medicare plans and has seen close to any situation. Christian believes in empowering people on Medicare by not just finding them a plan, but showing them and educating them on why that plan is a good fit. Christian hosts the most popular Medicare podcast on the internet called The Everything Medicare Podcast, written and published two books about Medicare, and is the founder of his own company that is dedicated to helping people on Medicare everywhere. Don't forget to like and subscribe for more videos! Helping people in Utah, Idaho, Colorado, Washington, Oregon, California, Texas, Virginia, West Virginia, South Carolina, North Carolina, Alabama, Florida, Arizona, Nevada, Alaska, Mississippi, Kentucky, Arkansas, Illinois, Kansas, Nebraska, Maryland, Georgia, Tennessee, Missouri, Indiana, Louisiana, Pennsylvania, Maine, Michigan, Wisconsin. Visit our website for more information: www.christianbrindleinsuranceservices.com Pick up Christian's Medicare Guidance book and learn everything you need to know to make a good choice: https://www.amazon.com/Medicare-Guida... Follow us on social! Facebook: https://www.facebook.com/christianbri... Instagram: https://www.instagram.com/christianbr... Twitter: https://twitter.com/C_E_Brindle #Medicare #Medigap #Insurance #HealthInsurance #Health #Healthcare #Medicaresupplement #MedicareAdvantage #Medicare2021 #Medicarehealthplan #InsuranceAgent #MedicarePodcast Medicare, Medigap, Medicare Supplement, Insurance, Health Insurance, Health, Healthcare, HAS, Retire, Retirement, Social Security, Christian Brindle, FICA, Medicare Podcast, Medicare Advantage, Medicaid, Medicare Part A, Medicare Part B, FICA, FICA Tax, Retirement, Retire
Les points clés de cet épisode étaient:Comment fonctionne le système de santé aux Etats-Unis ?Qu'est-ce qui choque les immigrants Africains dans le système médical aux Etats-Unis ?Permission de toucherPoursuite en justiceSeconde opinion HIPAA privacy - le dossier medical Envoi des prescriptions vers la pharmacieComment se soigner aux Etats-Unis quand on n'a pas d'assurance santé ?MedicaidONG offre des soins gratuits / free ClinicLes soins dentaires et oculaires aux Etats-Unis
Jason Neufeld, Esq. is the founding partner of Elder Needs Law, PLLC which focuses on a variety of Florida Elder Law matters including Estate Planning, Medicaid-Planning, probate and guardianship matters. Jason is consistently recognized as a top lawyer among his peers in Super Lawyers Magazine and Florida Trends Legal Elite. Jason is an author and on the board of the Academy of Florida Elder Law Attorneys and Co-Chair of the Broward County Bar Association Elder Law Section. Sponsor: https://www.seniorcareauthority.com
Andy Field - ABC Correspondent in Washington DC Nearly 100 million U.S. workers will be required to get the COVID vaccine by Jan. 4, with some workers allowed to test weekly instead, under sweeping federal rules released today by the Biden administration that identifies COVID-19 as an occupational hazard. The regulations are aimed at health care workers and businesses with 100 or more employees, covering two-thirds of the nation's workforce. Businesses that don't comply could be fined $14,000 per infraction, and hospitals could lose access to Medicare and Medicaid dollars. Once divided on how to address the pandemic, Republican governors have united against the plan, insisting it represents dangerous federal overreach and would cripple business owners already dealing with worker shortages. Supporters counter that many large businesses have already embraced vaccine mandates to both entice employees who want a safe workplace and end a pandemic that has hobbled the economy. They argue too that whenever employers have enacted mandates, the vast majority of workers comply. (The Walt Disney Company, the parent of ABC News, requires all of its new, salaried and non-union hourly employees to get vaccinated before heading to work.) See omnystudio.com/listener for privacy information.
Oklahoma gears up to vaccinate kids under 12. More than 200,000 Oklahomans enroll for Medicaid expansion. The OSU men's basketball team gets denied appeal on its postseason ban. You can find the KOSU Daily wherever you get your podcasts, you can also subscribe, rate us and leave a comment. You can keep up to date on all the latest news throughout the day at KOSU.org and make sure to follow us on Facebook, Twitter and Instagram at KOSU Radio. This is The KOSU Daily, Oklahoma news, every weekday.
Letting private insurers offer Medicaid coverage was supposed to lower costs and improve care. We dig into the research on Medicaid managed care.Guests:Sayeh Nikpay, PhD, Tradeoffs Contributing Research Editor; Associate Professor of Health Policy and Management, University of MinnesotaKathleen Adams, PhD, Professor of Health Policy and Management, Rollins School of Public Health at Emory UniversityAllan Baumgarten, JD, Independent Health Policy AnalystRead more of the research on Medicaid managed care and find a full transcript on our website: https://tradeoffs.org/2021/11/04/medicaid-managed-care/ Sign up for our weekly newsletter to see what research health policy experts are reading right now, plus recommendations from our staff: bit.ly/tradeoffsnewsletterSupport this type of journalism today, with a gift. If you give before Dec. 31, 2021, your donation will be doubled thanks to a match from the Institute for Nonprofit News: https://tradeoffs.org/donateFollow us on Twitter: https://twitter.com/tradeoffspod See acast.com/privacy for privacy and opt-out information.
Each day, SDPB brings you statewide news coverage. We then compile those stories into a daily podcast.
Nov. 3, 2021 - Assembly Health Committee Chair Dick Gottfried, a Manhattan Democrat, recently solicited testimony about improving the state's Medicaid program, as he prepared to secure a major increased investment in the program in the upcoming budget process.
What can a medical assistant do – and not do?Medical assistants have a narrow list of tasks they can perform for patients or for a doctor in a doctor's office. It's often difficult to know what's allowed, because there are not strong laws or regulations in place regarding medical assistants.Since no one really “regulates” them, and they are frighteningly under-monitored by any sort of government agency, what rules should they follow?In the next live edition of Talk Ten Tuesdays, Terry Fletcher, a nationally recognized professional coder, auditor, and educator, will return to the broadcast with an exclusive report on best practices for medical assistants, but also the imperative admonition: they should not be mistakenly used as nurses.The live broadcast will also feature these other segments:Special Series: Maternal Morbidity and Mortality: Senior healthcare consultant Kristi Pollard, Director of Coding Quality and Education for the Haugen Consulting Group, will continue her four-part series, reporting how coded data is being used by the Alliance for Innovation on Maternal Health (AIM) to improve maternal outcomes.The Coding Report: Laurie Johnson will report on the on the outcome of the recent ICD-10 Coordination and Maintenance Committee meeting.RegWatch: Stanley Nachimson, former Centers for Medicare & Medicaid Services (CMS) career professional-turned-well-known healthcare IT authority, will report on the latest regulatory news coming out of Washington, D.C.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, will anchor the Talk Ten Tuesdays News Desk.TalkBack: Erica Remer, MD, founder and president of Erica Remer, MD, Inc., and Talk Ten Tuesdays co-host, will report on a subject that has caught her attention during her popular segment.
Dr. Adaeze Enekwechi is a leading voice in health equity and evidence-based health policy making who is committed to meaningfully improve access to equitable, quality healthcare for all Americans. Dr. Enekwechi is currently an operating partner with Private Equity firm Welsch, Carson, Anderson & Stowe and serves on the Boards of several companies. She is also currently a Research Associate Professor of Health Policy and Management at the Milken Institute School of Public Health at the George Washington University and is an Executive in Residence at The Health Academy. Her research areas cover the aging population and Medicare, health equity for vulnerable populations, and evidence-based policymaking all of which are important topics that I look forward to covering today. Show notes: Books: The Love Songs of w.e.b. du bois by Honoree Fanonne Jeffers; When No One Is Watching by Alyssa Cole; I Alone Can Fix IT: Donald J. Trump's Final Catastrophic Year by Carol Leonnig and Philip Rucker.
This is the Everything Medicare Podcast hosted by Christian Brindle. It can be found on most major platforms that podcasts can be found. Christian Brindle was raised & brought up around the insurance industry. With his dad being an insurance broker for close to 30 years, Christian had the luxury of being able to learn all about the industry from a young age. Christian has worked with people far and wide on their Medicare plans and has seen close to any situation. Christian believes in empowering people on Medicare by not just finding them a plan, but showing them and educating them on why that plan is a good fit. Christian hosts the most popular Medicare podcast on the internet called The Everything Medicare Podcast, written and published two books about Medicare, and is the founder of his own company that is dedicated to helping people on Medicare everywhere. Don't forget to like and subscribe for more videos! Helping people in Utah, Idaho, Colorado, Washington, Oregon, California, Texas, Virginia, West Virginia, South Carolina, North Carolina, Alabama, Florida, Arizona, Nevada, Alaska, Mississippi, Kentucky, Arkansas, Illinois, Kansas, Nebraska, Maryland, Georgia, Tennessee, Missouri, Indiana, Louisiana, Pennsylvania, Maine, Michigan, Wisconsin. Visit our website for more information: www.christianbrindleinsuranceservices.com Pick up Christian's Medicare Guidance book and learn everything you need to know to make a good choice: https://www.amazon.com/Medicare-Guida... Follow us on social! Facebook: https://www.facebook.com/christianbri... Instagram: https://www.instagram.com/christianbr... Twitter: https://twitter.com/C_E_Brindle #Medicare #Medigap #Insurance #HealthInsurance #Health #Healthcare #Medicaresupplement #MedicareAdvantage #Medicare2021 #Medicarehealthplan #InsuranceAgent #MedicarePodcast Medicare, Medigap, Medicare Supplement, Insurance, Health Insurance, Health, Healthcare, HAS, Retire, Retirement, Social Security, Christian Brindle, FICA, Medicare Podcast, Medicare Advantage, Medicaid, Medicare Part A, Medicare Part B, FICA, FICA Tax, Retirement, Retire
Temas de hoy: Finalmente se le hizo justicia a Arellys. Culpable Jensen Medina. Todo tiende a indicar que el Presidente de LUMA o entrega la información o va preso Luego de jurar que NO, Junta acepta ley aprobada esta semana. Jueza dice Junta va a revisar el plan de ajuste. Histórica propuesta para Puerto Rico de parte de Biden y los demócratas: Medicaid, SSI e incentivos contributivos para la inversión Enfrentados Senado y el Gobernador por nombramientos Paro de policías este fin de semana Deportes Zona 5 con Federico López See omnystudio.com/listener for privacy information.
Sam and Emma take stock of a big last few days in news, from reconciliation negotiations to the courts, immigration to labor, and more! After giving a little foreshadowing to the discussion on the billionaire tax, they dive into Manchin still floundering in front of climate activists, even when they accost him on solid ground, and Bernie continues to center Medicare expansion in negotiating power and for dental, hearing, and vision. Next, Sam really gets into his flow as he and Emma walk through all of the details of the proposed changes to the tax structure, and what changes Manchin and Sinema are standing in front of, particularly discussing the proposal for corporate minimum tax rate, before they move into the absurdity of Washington's obsession with “pay-fors,” and the incredible value of a billionaires tax. Then, Emma and Sam run down what is and isn't in reconciliation, and what has been cut in half; they talk the Child Tax Credit and its single-year extension, the disappearance of free community college, Bernie's medicare expansions still hanging in limbo, a complete cutting of the expansive paid leave proposal, Manchin's hindrance of climate provisions and Medicaid federalization, and the halving of housing aid and eldercare. And in the Fun Half: Mike from Jersey talks paternity leave, Joe Rogan talks paternity leave but poorly, and Ronald Raygun and Sam start to mend their pome-based beef, before Oscar from NoLa calls in for a heavy discussion on immigration, reconciliation, and helping out dreamers. Norris from Pittsburgh calls in to promote his “No Child Left…” policy, Jay from Long Island asks about the NYS Senate ballot proposal, and Charlie Kirk really puts on a show as he tampers the violent tendencies of his base just enough to keep them angry and keep himself away from responsibility. Dave Rubin calls out liberals misappropriating his culture as they call people Nazis, and Sam takes on why, at this point, the Build Back Better plan will not ever be seen as a win for Democrats, plus, your calls and IMs! Purchase tickets for the live show in Boston on January 16th HERE! Become a member at JoinTheMajorityReport.com Subscribe to the AMQuickie newsletter here. Join the Majority Report Discord! http://majoritydiscord.com/ Get all your MR merch at our store https://shop.majorityreportradio.com/ (Merch issues and concerns can be addressed here: majorityreportstore@mirrorimage.com) You can now watch the livestream on Twitch Check out today's sponsor: sunsetlakecbd is a majority employee owned farm in Vermont, producing 100% pesticide free CBD products. Great company, great product and fans of the show! Use code Leftisbest and get 20% off at http://www.sunsetlakecbd.com. And now Sunset Lake CBD has donated $2500 to the Nurses strike fund, and we encourage MR listeners to help if they can. Here's a link to where folks can donate: https://forms.massnurses.org/we-stand-with-st-vincents-nurses/ Support the St. Vincent Nurses today as they continue to strike for a fair contract! https://action.massnurses.org/we-stand-with-st-vincents-nurses/ Subscribe to Discourse Blog, a newsletter and website for progressive essays and related fun partly run by AM Quickie writer Jack Crosbie. https://discourseblog.com/ Subscribe to AM Quickie writer Corey Pein's podcast News from Nowhere, at https://www.patreon.com/newsfromnowhere Check out Matt's show, Left Reckoning, on Youtube, and subscribe on Patreon! Subscribe to Matt's other show Literary Hangover on Patreon! Check out The Letterhack's upcoming Kickstarter project for his new graphic novel! https://www.kickstarter.com/projects/milagrocomic/milagro-heroe-de-las-calles Check out Matt Binder's YouTube channel! Subscribe to Brandon's show The Discourse on Patreon! Check out The Nomiki Show live at 3 pm ET on YouTube at patreon.com/thenomikishow Check out Jamie's podcast, The Antifada, at patreon.com/theantifada, on iTunes, or at twitch.tv/theantifada (streaming every Monday, Wednesday, Thursday and Friday at 7pm ET!) Follow the Majority Report crew on Twitter: @SamSeder @EmmaVigeland @MattBinder @MattLech @BF1nn @BradKAlsop Donate to the Kellogg's Local 50G Strikers GoFundMe here.
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