Steven McDonald

🌟 Exciting News! 🌟 I’m thrilled to announce the latest episode of the Healthy, Wealthy, and Smart Podcast, where I had the pleasure of welcoming back Dr. Efosa Guobadia, DPT, MBA, CEO of FFITT Health and Move Together, and co-founder of the PT Day of Service. This year marks the 10th anniversary of this incredible initiative, and we had a deep and inspiring conversation about the power of service in the physical therapy profession. Here are three key takeaways from our discussion that I believe everyone in our field can benefit from: The Power of Community Engagement: The PT Day of Service started with a simple idea: what if we could unite physical therapists worldwide to serve their communities on the same day? We saw participation from all 50 states and 26 countries in its first year! This initiative has grown to include 80 distinct countries, showcasing the incredible impact we can have when we come together. If you want to get involved, consider partnering with local nonprofits to create meaningful service projects that resonate with your community. Service as a Remedy for Burnout: We discussed the rising issue of burnout in our profession, especially in the wake of the pandemic. Efosa shared a powerful perspective: engaging in acts of service can help alleviate feelings of burnout. By focusing on the needs of others, we can find renewed purpose and connection in our work. It’s a reminder that service doesn’t just benefit those we help; it enriches our lives and careers. Movement and Health Go Hand in Hand: We must weave movement elements into our service initiatives as we celebrate Physical Therapy Awareness Month. Whether conducting fall prevention screenings for older adults or teaching injury prevention techniques to local sports teams, we can promote movement health while building community relationships. This dual focus raises awareness about our profession and establishes us as trusted resources for health and wellness. I encourage you to listen to this episode and reflect on how you can contribute to your community through service. Let’s make October 12th a day to remember, not just for physical therapists, but for everyone we can impact through our work. 🎧 Tune in now to hear the full conversation and get inspired to take action! https://bit.ly/3ZvI59W #PTDayofService #PhysicalTherapy #CommunityEngagement #Burnout #MovementHealth #HealthyWealthySmartPodcast

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My cellular health pro tip of the week sounds simple but is remarkably difficult to execute. This weeks tip is summarized in just 3 words. Only. Eat. Food. Simple right? Make sure your inputs are holistic and natural to facilitate better methylation of nutrients at the cellular level. Reving up that engine will provide the boost in ATP production needed to eliminate toxins that have bioaccumulated in our cytoplasm over the time. Sounds like a pretty good plan, right? Unfortunately, the best laid plans of mice and men oft go awry. Sadly, this is an extraordinarily difficult plan to execute in the modern age of mass produced, highly processed foods. These so-called foods come with man-made chemicals, pesticides and preservatives. Furthermore, there are a number of other toxic touch points in our food chain in the farm to store process. The result is that our nutrients come packaged for arrival into our digestive tract with a host of man-made chemicals that our bodies simply are not designed to process and eliminate successfully. Consuming these things in moderation over time will simply moderately poison you over time. So… what is the byproduct of this slow, systematic poisoning over time on our health at a cellular level? Inflammation. Our bucket overflows… sometimes triggering acute onset of autoimmune disease or, more often, the gradual onset of symptoms that can worsen over time. Sounds grim, Eric, what can we do about it? Remove as many self-inflicted toxic inputs as possible from your daily regimen! A great place to start is what you eat. If God didn’t make it. You probably shouldn’t eat it. Only eat food. Stay healthy, my friends!

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When it comes to healthcare, we've created an enormously complex system that puts up so many barriers and misaligned incentives. For too long, we've rewarded physicians largely based on volume - how many procedures, tests, and visits they can bill for. But that's not really getting at the heart of what patients need--which is high quality, cost-effective care focused on positive outcomes. We're human, and I think as doctors, there can be a temptation to overcompensate by ordering extras 'just to be safe.' But that defensive practice drives up costs without necessarily improving quality. We have to get vulnerable and ask - what are we really afraid of if we don't do that extra test? How do we keep patients happy with their care and avoid unnecessary procedures or medications they saw advertised? How can we build resilient systems built on trust rather than covering our assets? We need to take courageous risks, leaning bravely into discomfort to align incentives so doctors are rewarded for healthy patient outcomes at a reasonable cost - keeping people out of the hospital when possible through preventive care, coordinating to reduce duplicative services, and practicing wise stewardship of resources. Value over volume. And this focus on value is here to stay as the costs of healthcare in the US have continued to rise without a parallel increase in quality! How can we be the country spending the most on health care but still not falling far short of taking the best care of our patients? It’s because our incentives are not aligned with value in our broken healthcare system. We pay the same if you give great care or if your care leaves much to be desired… Trust me that I understand it’s not easy to change these huge, entrenched systems. There will be fear and resistance. But I truly believe if we lean into what is right for the patients, we can align pay for physician with the altruistic aims that brought most of us to medicine in the fire plan. We can rebuild a more patient centered, effective model that not only serves our communities but keeps doctors engaged and happy. So why wouldn’t we lean into this world of value- based care now and help shape the rules and rewards instead of waiting until someone else has decided our destiny? We know better so now we must do better—venturing into this new uncomfortable arena ready to challenge our current status quo. Will you join me in this endeavor?

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We suffer from gross misalignment of incentives in the US Healthcare System. If we only aligned the PCP compensation with patients and companies paying for care we would be eons ahead in improving health. How to do this is the challenge. Advanced Prepaid Primary Care with appropriate incentives is one way that is gaining traction. Key variables that must be considered include: - Reducing health risk is #1 - everyone wins (except the illness care system). this includes preventive services, health literacy, and healthcare navigation & support. - Measuring trust & the relationship between PCP and patient - Total cost of care reduction with reduced ER, specialist, inpatient, and procedural costs - many of which are inappropriate, dangerous and costly. Josh M. Berlin Michael Fine Dr. Wayne Jonas Laurence Bauer Peter Hayes Jeffrey Hogan Christopher Crow, MD, MBA Primary Care Collaborative Catalyst Health Group American Academy of Family Physicians American Board of Family Medicine Bryce Heinbaugh, MBA - Healthcare Trailblazer Alan Roth Blair Thwaites Trevor Huber D.O., FAAFP, DABFM Stanley Schwartz MD Scott Haas Luigi Tullo Sara Pastoor, MD, MHA, FAAFP Patrick Nelli Lee Lewis #innovation #healthinnovation #advancedprimarycare #apc #directrimarycare #dpc #healthinnovation #healthbenefitinnovation #healthrisk #trustiscurrencyprimarycare #healthliteracy #primarycare revolution #newhealthcaresystem #betterheatlhcaresystem #wholepersonriskscore #intuitivewellbeing #highvaluevisits #personalhealthassistant #MyPHA #intuitiveanalytics #healthcareanalytics #advancedprimarycare #APC #Directprimarycare #valuebasedcare #medicareadvantage #populationhealth #wholepersoncare #healthcare innovation

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What would it take for CMS to actually have sufficient primary care by 2030. Spending in primary care would need to go up, not down as in 5.8% to 4.6% of total spending as indicated by the Milbank Scorecard 2010 to 2020 (purple squares at bottom). Flat lined 250 billion in primary care spending with cuts and new types of costs added can only decline capacity by about 20 - 30 billion or 10% of capacity year after year due to less workforce and other team members supported (green line). Worst case orange line reflects cuts, higher turnover costs, even worse retention, and higher costs of delivery. Primary care delivery capacity should have continued to increase slightly faster than population growth (purple line), ideally at 2% annual increase (turquoise) to cover population increases and increases in a number of complexities. Fewer and fewer primary care years per class year indicate declines, not advances. Primary care retention would need to increase. It continues to decline for all 5 sources decade after decade. CMS would have to prioritize delivery team member numbers and quality while decreasing metrics, micromanagement, and team member burdens. CMS would have to focus on volume increases rather than volume to value. In primary care, volume is what enhances access. In particular the cost cutting and overutilization focus must go away for 40% of the nation with half enough primary care and basics where underutilization and inappropriate utilization worsen by the financial design. The nation would have to address the fatal flaw of employer based health insurance - payments lower than cost of delivery where the weaker employers are concentrated. CMS would have to increase payments to 110% of the cost of delivery, up from 60 - 85% CMS would need to audit its plans and discipline them such that lower payments are not associated with lower levels of workforce - as in 15% lower office payments for primary care where it is half enough for 40% of the population in 2621 counties across vast regions. Primary care year production since the class of 2010 needed to exhibit regular annual increases in the numbers of primary care years from IM NP FM PA and PD (blue line) CMS would have to look back historically and see that the only major increase in primary care was 1965 to 1980 with the new billions from the original Medicare and Medicaid design (blue line left) CMS would need to understand that no training design, especially graduate medical education funding, can address deficits of primary care and basics where the public plans and worst private employer based plans are concentrated. CMS would need to see that its designs prevent improvements in PC delivery capacity including regulatory capture, RBRVS, budget neutrality, and better payments and more lines of revenue for those larger - especially when CMS votes its 1.4 trillion annual budget against basic health access.

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I was in the middle of a conversation about healthcare in the US the other day when it dawned on me: we’re trying to answer the wrong question. The folks I was talking to were convinced all the woes of American healthcare could be solved through a Free Market approach to health coverage. They vehemently opposed a government-sponsored, single payer system. They were missing the point, I realized. They were fixated on the wrong question. To me, it’s less a question of where the money to pay medical expenses comes from or who administers that money and rather more about how and where the money is spent – what are the incentives driving the system? It’s the design of the healthcare delivery system’s incentives that is important, not the payer source or style. Whether it’s a Free-Market System or a Universal Coverage System, if it incentivizes transactional encounters rather than outcomes, it will yield poor results, spend more and more money, and continue to frustrate us all. If, though, the financial incentives are aligned with optimized health and well-being, we’ll start to create value, have improved outcomes, and rein in medical costs. Read more in the attached document ….

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You’ve all heard of the GLP-1s at this point. They are projected to be the highest grossing medications of all time in the next decade. It may be right for some and this is certainly not medical advice. But there also exists much disinformation around this class of meds. In this commentary we propose a structured approach to how clinicians and public health should address this new era. (1) How to tackle the off-label usage of GLP-1 agonists to alleviate shortages for populations with diabetes (2) Initiating unbiased research on GLP-1 agonist use and associated risk factors (3) Ensuring accurate health information is disseminated on social media platforms to deter misinformation Proud of the work by Grace Wang Faraan Rahim and others to shed light on this important topic!

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With a high enough false positive rate, early cancer screening will be a net negative for humanity. This is a statement which will be obvious to clinicians and will seem nonsensical to most others. This is also the problem with whole body MRIs for cancer detection, the general public consensus thinking here is that routine whole body screening MRIs will help detect early cancer. The primary problem with this approach is: 1. MRIs are not a diagnostic tool for cancer, they can only screen for possible cancer which then requires a biopsy for diagnosis. 2. The problem here isn't necessarily that we don't have enough data, there is little reason to think that by increasing the frequency of MRIs they will be able to then diagnose cancer. We use pathology to diagnose cancer. 3. Pathology is distinctly different than MRI, it involves physically cutting the specimen and looking at it under a microscope with the help of various dyes/ stains. 4. The primary problem here is resolution and the absence of a corollary to the dyes/ stains used for cancer diagnosis. 5. MRIs are not the answer to cancer diagnosis, we need a tool which allows us cellular vision and possibly a replacement for the dyes/stains pathologists use. 6. Lastly, the problem with iterating post launch in healthcare is that is increase the probability of significant patient harm. A high false positive rate leads to unnecessary biopsies which leads to an increase in complications (from these biopsies) ranging from infection to death. 7. We already know this from data in prostate cancer screening (with PSA) and it appears are repeating the same mistake again. #cancerscreening #prevention #publichealth

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A large number of teens vape because e-nicotine device manufacturers use youth-oriented marketing practices and flavorings and retailers don’t employ practices to stop youth direct and indirect purchases. Nicotine replacement therapy (NRT) options are not available for teens because they’re not FDA approved in that age group. Pediatricians and other health professionals working with preteens and teens are encouraged to regularly screen for vaping. Schools screen for and witness preteen/teen vaping. This study is exciting because it demonstrated how effective a longitudinal texting program to support teens quitting vaping can be. It’s hard to quit so don’t start. But go to your doctor if you want to quit #vaping and be successful. https://lnkd.in/eB346j2p

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