Bruce Berger, PhD

Wound care folks, I highly recommend reading CMS’ National Coverage Analysis Review (NCAR) document (8/7/2024): https://lnkd.in/ehUWRJfa . The “Methodological Principles” section offers valuable insights into evidence synthesis for coverage decisions. That said, I must take exception to the “Precision of Estimates” section, which states: “Precision is typically judged based on the width of the confidence interval and, more importantly, whether that interval encompasses values that suggest no meaningful effect and values that indicate a meaningful effect.” This is problematic for two reasons: 1️⃣ Confidence Intervals don’t provide probabilistic statements about the true parameter. Instead, they reflect long-run properties of repeated sampling. This is a statement about the data, not the parameter (or population treatment effect). This is a subtle but very important distinction. 2️⃣ Credible intervals (Bayesian) directly quantify the probability of a parameter (or population treatment effect) lying within a range, while Confidence Intervals (frequentist) do not. It’s fascinating—and concerning—that the National Coverage Review relies on Bayesian ideas while using frequentist terminology. This implicit and incompatible blending of frameworks can cause confusion and lead to inappropriate conclusions in wound care, especially with coverage implications like the CAMPS/Skin Sub LCD’s. Open Wound Research

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The number of drugs negotiated by the Federal government is set to increase in the coming years. President Biden has called for #Medicare to negotiate the prices of 500 drugs during the next decade. In reality, it's not a fight between government and industry. This The New York Times article outlines the orchestrated dance. #Healthcare #GovernmentNegotiation #Medicare #DrugPrices

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Are you presenting at #ECCB2024Bologna and worried you might be asked tricky questions? Here’s your friendly reminder: This isn’t a test and you can’t fail! Questions (especially critical ones) can help you think about your research in new ways, see gaps and come up with new solutions to problems that have been holding you back. Embrace questions and don’t be scared of not being able to answer them!

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Appreciate U.S. Department of Labor, U.S. Department of Health and Human Services (HHS), U.S. Department of the Treasury leadership making time to hear about opportunities to strengthen #mental #health parity -- a key priority for the American Medical Association! The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) was enacted in 2008, with final regulations issued in 2013. Despite this Administration—and previous Administration’s efforts— health plans have flouted rules and compliance for more than 15 years! According to the law patients, plan participants, beneficiaries, and enrollees should not face greater barriers and restrictions to accessing benefits for mental health conditions or substance use disorders than they face when accessing benefits for a medical condition or surgical condition. But we all know they do! It is time to take *meaningful* action against violations, require insurer accountability, and stop health plans from imposing barriers to mental health and substance use disorder care. This is essential to end the national mental health crisis and drug-related overdose and death epidemic. What is currently going on? An RTI International study found: (1) Out-of-network use was many times (9x) higher for behavioral health treatment than medical/surgical treatment, which created a significantly greater financial burden for behavioral health patients. This was true even for telebehavioral visits as compared to telemedicine visits. (2) Office visit in-network reimbursement levels were much lower for behavioral health providers than for medical/surgical providers creating disincentives for behavioral health providers to participate in-network. For example, psychiatrists and psychologists had lower reimbursements than physician assistants. (3) The disparities in out-of-network use have remained large over the last 9 years for office visits, where most behavioral health care is delivered. Health plans ought to be required to report approval and denial rates, reasons for denial, appeal rates, and denials overturned upon appeal for prior authorization and other utilization management programs and compare these outcomes data for MH/SUD care vs. those for medical/surgical treatment. It's just common sense. Finally, inadequate networks are one of the most significant barriers to individuals accessing needed MH/SUD care—multiple studies have clearly demonstrated health plans’ failures to comply with requirments. We must change this and it's time for the IRS to use its existing authority to levy fines against violations from single employer or multiple employer plans up to $500,000. Want to learn more? Check out: https://lnkd.in/gxkT7kXt

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LAST CALL - EVENT RUNS APRIL 30 BETTER WORK - BETTER CARE COALITION  WEBINAR How good are your improvement processes?   7 Strategies for Impactful Healthcare Improvement Processes   April 30, 2024 (12:30pm to 1:30pm EST)                                       FREE REGISTRATION: https://lnkd.in/gyFHTn9D                          Many organizations struggle to manage their improvement processes in ways that meet the needs of their people. While buzzwords like the “Quadruple aim” are consistent with the Better Work Better Care agenda, less is known about how such approaches are to be implemented. We have articulated 7 key strategies for organizational change management that can help. Don’t get caught with a myopic improvement approach! Come join the discussion and develop a more strategic approach to developing your organization's change and improvement capacity.  Please share within your networks and invite a colleague! #BWBCare  #Healthcarequality  #Nurseworkload #Carequality #Healthcaremanagement #processimprovement #changemanagement

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In the #340B Spin Room Predictably, covered entities and their advocates are in full spin mode following the Health Resources and Services Administration (HRSAgov), HHS, announcement that the program expanded by an astonishing 24% last year. The spin room’s spin doesn’t seem particularly convincing to me, but, more to the point, it ignores the patient. Here’s the spin as catalogued in a (very interesting) article by William Newton at the 340B Report, citing an impressive array of covered entity #advocates: 1) “The growth in total 340B purchases last year was largely a result of drugmaker #price increases….”; “Exploding drug price increases” are the primary reason for the program growth. I think not. As IQVIA has reported, “[o]verall spending growth in the U.S. market for #medicines slowed to 2.5% in 2023”. The 24% increase in 340B is almost 10x that rate of growth. Indeed, the article concedes a fundamental point that should have DECREASED 340B sales, measured, as HRSA did, based on dollars. As the article notes, quoting an advocate, “a new provision of the #InflationReductionAct“, which was implemented in 2023, “began penalizing #drugmakers for raising prices faster than #inflation, leading manufacturers to SLOW the rate of price increases….”. 2) The #HRSA report, another advocate says, “did not offer a side-by-side comparison to the non-340B prescription drug market”. Sorry. Nope. See above. The increase in the total market, inclusive of both non-340B and 340B, was 2.5%, while 340B increased 24%. 3) “Broader #healthcare trends” are “increasingly shift[ing]” care “from inpatient to outpatient settings”, and 340B is an outpatient only program. Well, sorry, that doesn’t really explain last year. Though it’s certainly true that, over the last 20 years, #inpatient services have declined and outpatient services have increased, #outpatient visits per 1000 people increased ONLY 0.3% from 2022 to 2023. But, for me, all of the sturm und drang over expansion isn’t even the be all and the end all of the debate; the patient is. And that’s where the spin really falls short. There’s no assertion in the spin room that assistance to patients at the #pharmacy counter has increased by 24%—or anything approaching that. Indeed, when IQVIA looked in 2022 at #patient assistance at contract #pharmacies, it found that a meager 1.4% of those patients received #assistance. Nor is there any suggestion in the spin room that charity care increased 24%. In fact, charity care percentages are moving COUNTER to 340B expansion. According to the Pioneer Institute, 340B hospital charity care ratios FELL by 46% from 2013 to 2022, with just 2.28% of operating expenses devoted to charity care in 2022. The spin just isn’t convincing. #lifesciences #drugpricing #patientsfirst #medicaldebt #affordability #Medicare #Medicaid #copays #coinsurance #costsharing #insurance

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"KFF reports published in 2020 and 2021 reviewed more than 600 studies and concluded that expansion is linked to gains in coverage, improvement in access and health, and economic benefits for states and providers." Should we believe that expansion did all 4? 1 out of 4 may be it as far as coverage, access, health, and economic benefit for most Americans most behind - the ones ignored for 40 years of designs. Coverage is it. Improvement in health was claimed? Really? - How can you end up with improvements in health since most Americans continue to decline across numerous outcome measures? What about 80% of outcomes shaped outside of clinical interventions? There are no increasing investments in people, particularly age 0 - 8 to improve outcomes the only way possible - by changing the population generation to generation. Improvements in access? - Access to care is completely disconnected from health insurance in this nation. Health insurance coverage differences shape and maintain half enough basic health access workforce for 40% of the nation. Coverage barriers and lack of acceptance of Medicaid and other worst quality health insurance plans makes this a higher proportion. There are direct barriers and vast regions where there half the workforce needed and even lower levels of delivery team members The biggest access problem in the United States has always been where the public plans paying 65 - 85% of cost of delivery are concentrated along with the weakest employers, often in the weakest states that shape and tolerate the worst public and private plans. In 2621 counties the expansions of worst paying plans only make the problem worse. They need better paying plans that pay 150 - 200% of Medicare rates to overcome the concentrations of elderly, poor, disabled, and worst public plans. Even worse, health care and education and government jobs are being cut and centralized away from these counties - with loss of better paying plans and losses of local leaders in health and other key areas. Expansion was not targeted to this 40% of the nation that had 40 - 41% of the population, the uninsured, and the unemployed. Their problem has always been worst quality worst paying insurance shaping half enough of each basic health access specialty and even lower levels of more specialized care. Paying more than costs of delivery can expand Access Delivery team member numbers Delivery team quality in continuity, experience, lack of turnover cost Expand the providers who accept that insurance, Expand Community Health Centers in all of the above Since expansion did little for half of the nation most behind, the economic impact was also missing in action When you set out to improve care for the elderly, poor, disabled and most Americans most behind, you might want to understand them https://lnkd.in/g4DAecjs

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🚀 Rethinking the Business Case for Total Worker Health® Interventions 🚀 Webinar: September 17, 2024, at 12:00 PM for an engaging discussion hosted by the Carolina Center on reimagining the business case for Total Worker Health® (TWH) interventions. The distinguished speakers, Jeremy Bray, PhD, and Bruce Sherman, MD, FCCP, FACOEM, will share their insights on the evolving landscape of workplace health interventions. Dr. Bray, an expert in the economic evaluation of workplace interventions, brings over 30 years of experience, while Dr. Sherman focuses on optimizing equitable workforce health and well-being investments. Key takeaways include: 🔹 NIOSH’s approach to the business case for TWH. 🔹 The Carolina Center’s new conceptual framework for building a compelling business case. 🔹 Insights on health equity, economic evaluation, and effective strategies for workforce health. Don’t miss this opportunity to learn from industry experts and rethink how we invest in worker health and well-being! Register now to secure your spot! https://lnkd.in/ez_puF3y #TotalWorkerHealth #WorkplaceWellbeing #EmployeeHealth #BusinessCase #HealthEquity #WorkplaceInterventions #WorkforceWellbeing #Leadership #HumanResources #CorporateWellbeing #CarolinaCenter

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Upcoming Free Learning Opportunities: Foundational Strategies for Emergency Preparedness within Health Centers Webinar TOMORROW 4/18 1-2pm ET/10-11am PT Join our upcoming webinar to explore key strategies for emergency preparedness and addressing environmental impacts on health within health centers. Expert faculty will guide participants in understanding the purpose of implementing an emergency preparedness plan and provide foundational knowledge on best practices for preparing for emergencies and environmental impacts on health. Participants will leave with increased confidence in beginning the development of an Emergency Preparedness Committee and Plan, ensuring patient safety during natural or man-made disruptions. Developing an Emergency Preparedness Plan for Your Health Center Activity Session 4/30 1-2 pm ET /10-11am PT Join us for an engaging follow-up to the Foundational Strategies for Emergency Preparedness within Health Centers webinar, offering a unique opportunity to receive coaching on beginning to craft an emergency preparedness plan (EPP) tailored to your health center's needs. Using CHCI best practices as a framework, participants will gain the knowledge and confidence to create a comprehensive resource to guide their emergency preparedness initiatives. Learn more/register: https://chc1.co/4aCQgnz

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Upcoming Free Learning Opportunities: Foundational Strategies for Emergency Preparedness within Health Centers Webinar TOMORROW 4/18 1-2pm ET/10-11am PT Join our upcoming webinar to explore key strategies for emergency preparedness and addressing environmental impacts on health within health centers. Expert faculty will guide participants in understanding the purpose of implementing an emergency preparedness plan and provide foundational knowledge on best practices for preparing for emergencies and environmental impacts on health. Participants will leave with increased confidence in beginning the development of an Emergency Preparedness Committee and Plan, ensuring patient safety during natural or man-made disruptions. Developing an Emergency Preparedness Plan for Your Health Center Activity Session 4/30 1-2 pm ET /10-11am PT Join us for an engaging follow-up to the Foundational Strategies for Emergency Preparedness within Health Centers webinar, offering a unique opportunity to receive coaching on beginning to craft an emergency preparedness plan (EPP) tailored to your health center's needs. Using CHCI best practices as a framework, participants will gain the knowledge and confidence to create a comprehensive resource to guide their emergency preparedness initiatives. Learn more/register: https://chc1.co/4aCQgnz

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GINA 2024 key changes, based on evidence (where available) and consensus, include recommendations on the choice of initial treatment step for adults and adolescents. The GINA cycle of asthma management - asthma treatment is not just about medications. Get the full report: https://lnkd.in/d5-QkVCQ #asthmaeducation

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Kratom, derived from the leaves of the Mitragyna speciosa (Korth.) Havil., Family Rubiaceae, is a tree native to Southeast Asia. It is indigenous to Cambodia, Thailand, Indonesia, Malaysia, Myanmar, and Papua New Guinea, It has indeed garnered significant interest for its potential effects on health and well-being. It contains active compounds namely alkaloids, with mitragynine and 7-hydroxymitragynine being the most well-known. These substances can interact with opioid receptors in the brain, which may explain some of its effects on pain relief and opioid withdrawal symptoms. The 🥵 debate around kratom is multifaceted and includes considerations of both its potential benefits and risks: Potential Benefits: 1. Opioid Alternative: Some report using kratom to manage chronic pain as an alternative to prescription opioids, which can be highly addictive and have a high risk of overdose. 2. Opioid Withdrawal: Kratom may offer a means of reducing opioid withdrawal symptoms, serving as a step-down method for those seeking to overcome opioid addiction. 3. Mood Enhancement: Some have described mood elevation and an anti-anxiety effect after consuming kratom. Potential Risks: 1. Addiction and Withdrawal: While kratom is often used to alleviate opioid addiction, it too can be habit-forming. Some report developing dependence on kratom, experiencing withdrawal symptoms when they try to stop. 2. Health Risks: The use of kratom has been associated with a range of health issues, including liver toxicity, seizures, insomnia, and hallucinations. 3. Quality Control: Because it is not regulated in many areas, the purity and concentration of kratom products can vary greatly, leading to the potential for overdose or exposure to contaminants. Regulatory Perspectives: Some countries and states have banned kratom due to concerns about its safety and potential for abuse. For instance, the FDA has issued warnings about its use, citing concerns about toxicity and overdose, yet it remains a legal substance in many parts of the States. The Drug Enforcement Administration (DEA) has also considered classifying it as a Schedule I substance, which would categorize it alongside drugs like heroin and LSD, but as far as I know, this has not occurred. Research Needs: There is a consensus among many scientists and healthcare professionals that much more research is needed to fully understand the benefits and risks of kratom. High-quality, controlled studies could help clarify its efficacy and safety, which would be invaluable for informing regulatory decisions and medical recommendations. Conclusion: The title "Kratom: Dangerous Drug or Beneficial Botanical?" reflects the ongoing 🥵 debate about this substance. It underscores the need for a very careful, hard core science-based approach to policymaking that considers both the anecdotal reports of beneficial effects and the potential for harm. Continues below

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As #Helene recovery continues, read our blog coverage of #healthpolicy adaptations, especially in #Medicaid and long-term services and supports: https://lnkd.in/eKkU9BWu

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⚖️ Ask Congress to Pass the Living Donor Protection Act (LDPA) (H.R. 2923/S. 1384) ⚖️ Bill - H. R. 2923 - Living Donor Protection Act of 2023 Congress.gov link: https://lnkd.in/ejwZnZuB. ⚖️ Bill - S. 1384 - Living Donor Protection Act Congress.gov link: https://lnkd.in/eatNPzWj ⚖️ The Living Donor Protection Act (LDPA) is a bipartisan bill intended to: 🔹Prevent insurance discrimination against living organ donors by prohibiting life, disability, and long-term care insurers from denying coverage or charging higher premiums based solely on organ donor status. 🔹 The LDPA seeks to include living organ donation as a qualifying event under the Family and Medical Leave Act of 1993 (FMLA), ensuring organ donor job protection during surgery and recovery. ❓ Did you know that roughly one in four living organ donors face difficulties obtaining or affording life, disability, and long-term care insurance after their selfless act of donation? 📈 This statistic is not just concerning; it is unacceptable, especially when 12 kidney patients die each day waiting for a transplant. ⚖️ Together, we can ensure that living organ donors can give the gift of life without fear of insurance discrimination or job loss. 📧 How can you support the Living Donor Protection Act of 2023 (LDPA)? Please take a moment and send the letter using the link below to ask Congress to support the Living Donor Protection Act of 2023. Thank you for your time. National Kidney Foundation #mykidneyvoice

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Epidemiologic vs. Individual Causal Assessments in Medicolegal Contexts In the realm of medicolegal evaluations, causal assessments are paramount for discerning the relationship between risk factors and diseases. These assessments bifurcate into two primary domains: epidemiologic causal assessments and individual causal assessments. Each approach serves distinct purposes yet intertwines to provide a comprehensive understanding of disease causation, particularly in medicolegal scenarios. To read further, please visit: https://lnkd.in/eViPbYgV

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|𝗪𝗲𝗯𝗶𝗻𝗮𝗿| 💡 Don't miss this webinar about the WHO Operational Framework for Monitoring Social Determinants of Health Equity. The role of data in shaping policies that drive improvements in #HealthEquity will be discussed. Register now! 👇🏽

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