Stephen Ferrara, DNP, FAAN

Superb work in NEJM Catalyst from colleagues to further enhance patient-centric care through an ED in Home model with net savings of $1250/encounter. https://lnkd.in/edUJFAAp As an emergency physician doing similar work at Massachusetts General Hospital, I can attest to their experience and that of our patients who are absolutely delighted with such patient-centric care. Excellent clinical pathway especially for our seniors for whom it is often difficult to get to the ED and don't do as well once there. Common reasons for referral often include symptoms of lower clinical risk (safe for home eval) but still requiring same-day diagnostics +/- therapeutics, such as: mild shortness of breath, urinary symptoms, potential skin infection, generalized weakness, leg edema. Great description of the team/model in the article...in short, it consists of remote triage nurses and EDiH coordinators, community paramedics in the patient home obtaining diagnostics and administering therapeutics, and an emergency physician directing the care through a synchronous video-visit. The key for sustainability of these programs is of course meeting patient volume requirements to offset costs (15 encounters/day for this study). Great work Evan Berg, M.D. Gregory Snyder Meghan McGrath, MD and the entire team for further advancing our understanding of EDiH and the home-based care ecosystem. #futureofhealthcare #emergencycare #healthcaretech #mih #homebasedcare #homecenteredcare #telemedicine #virtualcare #health #pointofcare #pointofneed #careredesign

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Download the whitepaper to see how our teleNeurohospitalist program: 🏥 Reduced patient transfers ⭐ Improved quality of care 📈 Increased patient volume and case mix index 👩‍⚕️ Enhanced staff satisfaction https://lnkd.in/gACVT_5R

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"However, these savings—as much as $50 billion annually1—are unreported and not shown to improve care access for patients without adequate insurance.2,3" ---Well, the financial design is so bad that it has closed over 600 hospitals since DRG and the era of cost cutting. The financial design is the reason for closures and compromises. The 50 billion distributed to hospitals serving vulnerable populations (40 - 50% of US pop) would be some help due to the Era of Cost Cutting 1983 to 2030 or longer. "Per CMS’s budget neutrality principle in the Outpatient Prospective Payment System (OPPS), the $9 billion repayment must be offset by $7.8 billion of cuts to nondrug reimbursements." ---Budget neutrality and regulatory capture prevent any true reform to add support to the hospitals and practices serving most Americans most behind. Once again CMS is not accountable and must be reigned in even if it takes 50 years as it did for physician accountability over the last half of the 19th century and for human subject researchers over the last half of the 20th century. Medicare and Medicaid have failed for 2621 counties (40% of US) most behind and has primary care and basic health access except 1965 to 1978. What about the Belmont Principles and numerous violations? What about protection of vulnerable populations, informed consent (which requires prior study of consequences poorly done by CMS), or beneficent intent - especially with all three lining up consistently against the majority of the nation most behind time after time! Strike 1 for ethical and moral violations - CMS has demonstrated time and again the inability to protect their charges - vulnerable Americans. CMS most fails where there are concentrations of elderly, poor, disabled, and their worst public plans. Strike 2 - CMS has failed to do adequate studies of consequences prior to the implementations of policies since 1983 and including Medicaid Waivers which will steal more from team member support and give more for team members to do - with worst impacts on Community Health Centers with 50% Medicaid and in the most vulnerable populations highest in concentrations of Medicare, Medicaid, and Dual plans. Studies are done more to justify what CMS is doing rather than to protect most Americans most behind from consequences such as their providers rated poorly or penalized just for caring for these populations inherently lower in outcomes and drivers of outcomes (Readmissions, ACO shared savings, Star Ratings, others) Strike 3 - CMS fails for beneficent intent. The intent is cost cutting. CMS harms tens of millions with designs that have killed hundreds of hospitals and countless practices, delivery team members, and local leaders in health and other community areas. We know about some economic and access impacts from these losses, but the full impact and cascades of impacts are never studied. See comments for losses of jobs, income, leadership, and better health insurance

We need to keep learning and improving in #healthcare. We need to share (and publish) creative care models that work well, and work #together across teams, historic silos, and locations to help our patients, communities, and each other. 📌 This is a fantastic overview of a virtual care connection model with specialists and local teams working together to care for patients. ➡️ “The clinical consultation took place in the local clinic facility, with the support of the on-site team.” ➡️ “Laboratory testing and imaging studies were coordinated through community settings, and tertiary site–based surgical, health psychology, and nutritional teams also followed up with this patient via virtual care clinic visits.” ➡️ “By providing these clinical services closer to the patient’s home through a clinical facility, numerous objectives were achieved: (1) patients received thorough clinical assessment and care plans; (2) patients were less likely to use the hospital or ED; (3) patients were more likely to remain in the workforce; and (4) community health care was off-loaded, reducing burnout and improving workforce retention.” ➡️ “This approach combines virtual care with a cooperative care delivery model, where the aim is not to shift patient care from one provider to another, but to expand access for patients and to create both new and clinically appropriate care for each care participant, with the aim that improved access will lead to enhanced care outcomes and more efficient care utilization.” #StrongerTogether #CrossTeamCollaboration #PatientCenteredCare

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The inferiority of the American Illness Profit System becomes clearer day-by-day, here is just the latest in an endless sequence of reports showing a factual basis proving its inferiority. Yet nothing happens in Congress to correct any of this because the Congress members are so corrupt, and in the pocket of the corporations that control health care in this country. The only thing that is going to change this is how you vote in what may be the last real election in which you will ever be able to vote.

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Is Primary Care Patient Experience Associated with Provider-Patient Language Concordance and Use of Interpreters for Spanish-preferring Patients: A Systematic Literature Review https://lnkd.in/g7ahdedn

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❗ New Publication ❗ In this commentary, we draw attention to the evolution of various geriatric care approaches and the increasing need to enhance partnerships with and services and supports for family #caregivers.

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Book Reading Chapter 17. In the pandemic we were led by public health leaders who were hardworking but ignorant. We should do a course correction else we are headed for future mishandling of "pandemics" if we do not put the right leaders at the top. https://lnkd.in/dC9mrGUZ

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The better you take care of your Internal Customers/Stakeholders/Employees/Associates, the better they will be able to serve your External Customers. It's a win/win with retention, engagement, safe, quality, effective care, and your overall ROI! It's one of the most important investments of an organizations time and resources.

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Articles on Late Adulthood Here is the second in my series of articles on Late Adulthood published by "Excellent Care, Decency and Optimal Living" (ECDOL.org): "Late Adulthood: Options and Guides for Choosing Where to Live (Part 1)" Please see the link below: https://lnkd.in/e2VVTT9m #AgeInPlace, #Boomers, #Retirement, #eldercare, #seniorliving, #caregiving

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Similar situation in Canada but not always a bad thing. Family Drs with training for the widest scope often provide care in places where they lack services from other specialties eg in rural have GP Anesthetists and will choose focused practices if the pay is better than comprehensive office based practice. Govt can change this by promoting teams of MDs & health care providers to group themselves together to support broad scope primary care which means we need a definition of standard expectation of what a team should provide and a way to group according to fulfillment of services and aligned funding model with accountability! www.TeamPrimaryCare.ca

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None of us “enjoyed” the additional authority we needed during a public health emergency, and without this authority we would have struggled even more than we did. We learned a lot about that authority and we reaffirmed what is necessary to protect public health outside of an emergency. The challenge before us now is how do we balance the need for public health authority with the usual rights of citizens during “ordinary” times… This issue of Health Affairs presents an analysis of judicial decisions constraining public health powers during the COVID-19 pandemic -- a must read for my fellow public health leaders… New York State Association of County Health Officials (NYSACHO) https://lnkd.in/gfQsXQTy

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The latest episode of "The Critical Care Obstetrics Podcast" is now live! 🌟 "The WAR on Invasive Group A Strep " 🌟 Join us as Stephanie Martin and Suzanne Baird discuss a case of peripartum Invasive Group A strep and discuss how to wage WAR on this devastating condition.🤰💡 Tune in to gain insightful perspectives and practical strategies that could make a world of difference in critical care obstetrics. Don't miss this episode! 🎧 Listen, learn, and let's make a difference together. #groupastrep #necrotizing fasciitis #pregnancy #maternalmortality #maternalmorbidity

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📢New article alert from the Journal of Comparative Effectiveness Research:   Healthcare resource utilization among nursing home residents with Parkinson's disease psychosis: an analysis of Medicare beneficiaries treated with pimavanserin or other atypical antipsychotics   This study examines healthcare resource use among nursing home residents with Parkinson's disease psychosis treated with pimavanserin versus other atypical antipsychotics, including quetiapine. Findings show significantly lower hospitalization and emergency room visit rates for pimavanserin users compared to those on quetiapine or other atypical antipsychotics.   Authors: Krithika Rajagopalan, Nazia Rashid, Daksha Gopal & Dilesh Doshi Anlitiks Inc., Acadia Pharmaceuticals Inc.   #heor #HealthEconomics #ParkinsonsDisease #Psychosis #OpenAccess   https://lnkd.in/eUTjZwVh

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Dr. Sandra Davis, Deputy Chief Director of the NLN/Walden University College of Nursing Institute for Social Determinants of Health and Chair of the ICN Education Experts Advisory Committee (ICNEE), is attending the Global Partners Meeting for Nursing and Midwifery this week in Geneva, Switzerland. There are 152 countries attending the meeting in person, which is occurring one week before the 77th World Health Assembly and provides a strategic opportunity for policy dialogue and planning on nursing and midwifery contributions to stronger and more resilient communities and health systems. Meeting objectives include: -Enhance nursing and midwifery leadership at national, regional, and international levels in the context of broader health workforce, health systems, and global health priorities. -Take stock of progress and accelerate implementation of the Global Strategic Directions for Nursing and Midwifery 2021-2025. -Strengthen the engagement in and data reporting capacity for the State of the World’s Nursing 2025 and future State of the World’s Midwifery reports.

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A few years ago, I had the honor of giving a talk on how providers can better understand and manage patients with chronic and severe #AbdominalPain. These conditions can be complicated and impact a patient in a variety of ways from their physical health to their emotional well-being. I think there are still a lot of great takeaways from this presentation; check it out below and feel free to share your thoughts in the comments. #DGBI #Communication #PatientExperience

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✍️ A new essay: "For an Unremarkable Health System" 🏃🏼 We often celebrate remarkable achievements in healthcare — hospitals excelling on certain metrics or clinicians winning prestigious awards. But what if we shifted our focus to pursuing an “unremarkable” healthcare system instead? I examine this thesis in a new essay for Healthcare Quarterly. 🚶🏼 An unremarkable system performs consistently well across all indicators that matter to patients, without major deviations. It delivers “decent enough” results deserving of careful monitoring, but nothing remarkable that raises concerns. Rather than chasing a few standout metrics, an unremarkable system provides a balanced, holistic experience for patients across the care continuum. It seeks to maximize health and welfare for everyone by lifting all boats through quality improvement. Unremarkability requires a culture change from our tendency to seek to outclass peers. Doing “okay enough” all the time may be better than excelling in some areas while failing in others that impact patient care. 🙏🏻 Thank you to my editors at Longwoods Publishing… and to Zain Mujtaba, a spark of inspiration to me on this topic, and so many more! Neil Stuart Anne Wojtak Susmita Dey Dalla Lana School of Public Health, University of Toronto

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"The distortions were thought to discourage physicians from practicing in primary care specialties and in rural areas and to encourage a procedurally oriented style of care." This is the usual revelation - too little, too late, costing the nation too much, and resulting in little possible change in outcomes But there is much much worse damage via CMS and RBRVS in the 2621 counties most behind 1. Primary care 2. Mental health 3. Basic women's health 4. Geriatrics 5. Basic surgical 6. 40% of the pop in 2621 counties (37 million rural, 90 million urban) with 75% of services (above) suppressed not only by RBRVS but by 15% less for office payments documented in Medicare 2011 data 7. Prevention of integration, coordination due to insufficient/lesser delivery team members 8. Acceleration of turnover and costs of turnover at 10 - 15% of the revenue that a primary care physician can produce 9. Countless losses of locally focused leaders 50,000 primary care physicians short x 4 employees per physician x 2 because their spouses are also contributing to health, education, and other most needed civic leadership for about 1 million fewer local leaders Now multiply this times 3 for other basics Even 1 million more for local leadership in this 130 million could be a substantial force. Some of us did health fairs, weight control groups, STD clinics, work with law enforcement, Kiwanis, chamber of commerce, economic development, work with schools and programs, work with extension and farm bureau Now calculate the health insurance and leadership losses from the CMS killing of 400 plus hospitals x 40 - 70 employees x 2 for spouse plus losses of general specialists and their practices Not all of these administrators, professionals, managers, techs, and other delivery team members will contribute as leaders, but most will have impacts. Nearly all likely have have better jobs in these communities with better benefits and better insurance - much better than public plans paying less than cost of delivery. https://lnkd.in/gZshJNCz

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