Health Policy Expert Timothy Jost Anticipates Significant Setbacks With Repeal of ACA

Timothy JostThis week, hosts Mark Masselli and Margaret Flinter speak with health policy expert Timothy Jost, Emeritus Professor of Law at Washington and Lee University School of Law, and frequent contributor to Health Affairs. Professor Jost examines multiple gains made in health insurance coverage and access to care under the Affordable Care Act and the potential losses to millions of Americans with repeal and replace of the ACA.

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Leading Neuroscientist Dr. Adam Gazzaley Talks Drug-Free Brain Health Treatments Using Virtual Reality and Video Games

Adam GazzaleyThis week hosts Mark Masselli and Margaret Flinter speak with renowned neuroscientist Dr. Adam Gazzaley, Director of the Neuroscience Imaging Center and Gazzaley Lab at UC San Francisco. Dr. Gazzaley discusses his closed loop system designed to improve brain function through personalized game design and feedback, which are already undergoing FDA clinical trials for therapeutic interventions for a number of brain disorders including ADHD, aging brain, PTSD and addiction.

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Sara Collins, Vice President for Health Care Coverage and Access at the Commonwealth Fund

Sara CollinsThis week, hosts Mark Masselli and Margaret Flinter speak with Sara Collins, PhD, VP for Health Care Coverage and Access at the Commonwealth Fund which is dedicated to creating a high performance health care system for all Americans. She outlines the dramatic gains in coverage that have occurred since the passage of the Affordable Care Act, and the potential losses in coverage and rise in costs to consumers in the wake of ‘repeal and replace’ of the health care law.

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Trump Transition Adviser Michael Leavitt Addresses Future of Affordable Care Act

This week, hosts Mark Masselli and Margaret Flinter speak with Michael Leavitt, an advisor to President-elect Donald Trump’s transition team and former secretary of the Department of Health and Human Services under President George W. Bush. They discuss anticipated changes in health policy under the new administration including the future of the Affordable Care Act, the role of community health centers, and the need for bipartisan cooperation.

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Dr. Victor Dzau, President of the National Academy of Medicine

Victor DzauThis week, hosts Mark Masselli and Margaret Flinter speak with Dr. Victor Dzau, President of the National Academy of Medicine (the former Institute of Medicine) a private, non-profit entity dedicated to tackling the nation’s complex problems in medicine, technology and science. Dr. Dzau talks about the Academy’s shift towards more cooperation between the scientific disciplines to advance evidence-based research that will inform the health care providers and policy makers around the country and the world.

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Innovations Cleveland Clinic’s Toby Cosgrove Brings to Trump’s Healthcare Transition Team

Toby Cosgrove This week, hosts Mark Masselli and Margaret Flinter speak with Dr. Toby Cosgrove, President and CEO of the Cleveland Clinic, one of the top ranked hospital systems in the world. Dr. Cosgrove discusses the Cleveland Clinic Model of Innovation, their approach to 21st century health care, as well as Cleveland Clinic’s expansion around the globe.

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Dr Anna Lembke, Author of “Drug Dealer MD, How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard To Stop”

Anna Lembke

This week, hosts Mark Masselli and Margaret Flinter speak with Dr. Anna Lembke, Chief of Addiction Medicine at Stanford University School of Medicine, and author of Drug Dealer MD, How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard To Stop.  She examines the dramatic rise in opioid prescriptions and overdoses and the role the health care industry is playing in this crisis.

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Dr. Keith Yamamoto, Vice Chancelor for Science Policy and Strategy at UC San Francisco

Keith YamamotoThis week, hosts Mark Masselli and Margaret Flinter speak with Dr. Keith Yamamoto, Vice Chancellor for Science Policy and Strategy and Executive Vice Dean for Research at the School of Medicine at UC San Francisco. He discusses strategies for informing the incoming Trump administration – to ensure ongoing support for the nation’s biomedical research community, the need to advance precision medicine protocols and goals, and improvements needed to advance medical training and academic research in the 21st century.

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Why am I Still Here after 10 years?

Many years ago I joined forces with Dr. Iden, who had been practicing in the small town (pop. 3000) of Berryville, Virginia. He had been practicing over 40 yeas at the age of 70.  The office was a wonderful relic of the “golden Age” of medicine. A true PCMH…..The staff knew everyone, there were no appointments except for physicals. If the waiting room was full in the morning you came back after lunch. If you were too sick to come in, we went to your house. We saw the retired judge and we saw the migrant apple pickers. The nursing home was just a few blocks away and we even did Occupational Medicine for several manufactures in the area. I once used a screw driver from under the sink to remove a screw from a workers’ finger.  Doc Iden’s  doctor-father did not retire until he crashed his car into the wall in the hospital parking lot at the age of 90. Every year, Randy and his wife, the pharmacists gave us  a whole cooked Virginia ham for the holidays. (You have to be from Virginia to know what a cured Virginia ham is all about). The other pharmacy in town was one of the last old time pharmacies in the country and when that guy retired, the new pharmacy school that opened nearby packed up the entire shop and installed it as a museum in their building.

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Half the  medical charts were still kept on index cards stapled together. The note for a visit might read “11/15/1985, Pneumonia, Erythromycin”.

Whether the patient had insurance or not, the entire family’s leger was kept on a yellow card in a file box. Charges and payments were listed for the entire family without explanation whether it was an insurance or patient payment or for whom the charge or payment was entered! After I convinced my boss we needed to modernize ( and spend a lot of money to do it) he agreed with skepticism. I took it upon myself to computerize the office so that we could submit bills electronically and stop completing the infamous HCFA 1500 forms by hand. I knew my shiny new Apple computer and the program inside out. I was the IT department.  I could walk the office through restoring a crashed system by phone. I remember pulling all-nighters to set things up, fix bugs and do updates.

My next venture was my own start up office with 6 providers and a staff of about 15. Hiring and keeping a staff seven days and 4 nights a week can be exciting.  Doing the HR stuff, providing insurance as rates are skyrocketing, doing peer review and making sure nursing and everyone else is credentialed, insured and had flu shots is…….interesting. While ‘learning the business” as you go was a fun challenge for me, it was made more so by  having to pay the bills, which meant seeing a full load of patients and more. Now in 2016, my own doctor is struggling to keep their office independent.  His latest disheartening challenge is MACRA.

Getting this far with my missive, I realize it is Thanksgiving week. I am thankful to work for CHC, Inc. that does all those things for me. My biggest worry now is the patient. I know bugs in ECW happen but IT is there  to fix it. Insurance goes up but someone else researches the best options. I may be rushed and cut corners to get though the day, but I am pushed and prodded to “check the boxes” . My family gets sick and I can call out without anxiety about rescheduling all those patients.

I also know that we are leaders…on the cutting edge of innovation in a transformed and ever-changing world of medical care. At a meeting of FQHC leaders  a while back, I went to seminar after seminar where innovative ways of providing services were presented. Over and over I found myself saying, “We do that! We do that already! We do that too!”  It made me kind of proud to represent CHC.

What I do everyday is challenging. I see patients. I am doing what I signed up to do a long time ago.  I like it.

 

By: Hartmut A. Doerwaldt, MD

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Giving Back to the Community that Opened its Arms to My Family

Paulina Miklosz, nurse practitioner at CHC of New Britain, remembers the first time she came to the clinic in 1997.  “I was eight years old,” said Miklosz, whose family had just emigrated from Poland. She remembers the receptionist who spoke to her in Polish, the nurse who also spoke Polish and the translator who helped her communicate with pediatrician Robert Dudley during the physical exam.

“It was so reassuring to hear someone speaking our language,” said Miklosz.

Miklosz was drawn to nursing while attending New Britain High School where she completed a nursing assistant certification program. She then enrolled at Boston College and completed her bachelors and master’s degrees in nursing there.  She also studied Spanish, a language she knew would come in handy as a nurse practitioner.

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“I had studied Spanish in high school, and really missed it once I got to college so I decided to minor in Hispanic Studies and study abroad in Quito, Ecuador. I fell in love with the language and culture, and I wanted to be able to provide the same reassurance to Latino patients that I received from CHC’s Polish-speaking staff. I felt called to serve the community of New Britain, and I knew Spanish was something I needed to provide truly culturally competent care here.”

Miklosz is a graduate of CHC’s nurse practitioner residency program.  “The NP residency is a great way to transition from a grad program to full-time clinical practice and really hone one’s clinical skills,” said Miklosz.  “Specialty rotations and precepted clinics are built into the program so you are still learning how to best treat patients while building your own small panel. Residency programs really help NPs become well-rounded primary care providers.”

Miklosz is also currently enrolled in the doctoral nursing program at the University of Connecticut.  “I hope to use the training in my clinical work with the homeless, which has really become a passion of mine” said Miklosz, who works within CHC’s Wherever You Are (WYA) health care for the homeless program. “The NP residency is where I was first exposed to homeless care. I really enjoyed my WYA rotation during the residency and was fortunate enough to transition to WYA after 2 years at the New Britain CHC site.” Miklosz maintains a small Polish-speaking patient panel at the New Britain site where she continues to work one day a week.

“The nurse practitioner role is rooted in the nursing model which differs a bit from the medical model. NPs usually start out as RNs, caring for patients at the bedside and often supporting patients (and their families) through trying and difficult times.  This allows nurses to see the patient in a truly holistic way and identify patients’ psychosocial needs in addition to physical needs. I believe it’s imperative to keep those nursing principals firmly in mind as NPs continue to practice and advance their nursing career.”

Miklosz looks forward to continuing her work at CHC and, more specifically, in New Britain. “I feel very blessed for the opportunity to give back to the community that opened its arms to my family 18 years ago.”

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