Consulo Indicium - 8/14/23

Information for your Consideration… 

You Probably Missed It? Once a year over a relatively short period of time we celebrate one of Maine’s best products. What am I talking about? The 3rd Annual Wild Blueberry Weekend in Maine. It’s generally held the first weekend of August so you can plan for next year 😊. Why is this so important? First of all, blueberries – often referred to as a “superfood” – are an excellent source of nutrients. And, “wild” blueberries are absolutely the VERY BEST! Those tiny berries (about the size of pea) are known to help in lowering blood pressure, preventing heart disease, reducing cancer, improving memory, preventing premature aging, aiding in exercise recovery, and a whole lot more. In fact, I try to eat them as much as possible!! Factoid: Maine produces 99% of all blueberries in the country which makes the state the single largest domestic producer of the fruit. Farmers harvested nearly 78 million pounds of blueberries in 2022 and the production is expected to grow this year. But, the most important piece of information is that “wild” blueberries are exceptionally “blueberryie”, nutritious and wonderful – far better than those larger, chubby blueberries you often find from elsewhere (e.g. New Jersey). So, consider a visit to Maine next year during blueberry season. You will not be disappointed. And, “P.S.” – Maine has other attributes as well… 

Kudos To The College Board – On Thursday, August 3rd, the College Board – which oversees the curricular offerings by colleges and universities across the nation sent a notice to the Florida State Board of Higher Education noting that they should no longer offer AP Psychology courses to entering students because a state law was passed banning the inclusion of references to human sexuality and gender identify. KUDOs to the College Board. Psychology is an important foundation for many professional degree programs. It is very clear to me that we should NOT be having state legislatures – regardless of political affiliation – defining the content of professional training. To explicitly demarcate a portion of training because some legislators don’t like it is to expunge training on issues and problems that cut across all sorts of pre-conceived notions of adequate training. Psychology is an essential part of training not just for psychologists but also physicians, nurses, social workers, nutritionists, advertising executives, business leaders and others (you get the point!). In fact, Psychology is frequently a pre-requisite for entry to many professional programs. As Arthur Evans, CEO of the American Psychological Association stated in announcing the College Board decision: “…parsing out human sexuality and gender identification is like taking division out of math training.” Well said!! Legislatures across the country are becoming micro-managers of curricular programs in all sorts of professions to the detriment of those professions. The legislatures or a state’s elected officials frequently appoint or name the participants on the state professional oversight bodies. They should allow those bodies to do their work. I could go on but…you get the point! 

Let’s Solve The Problem – The Commonwealth Fund is reporting that the United States holds the unfortunate distinction of having the biggest geographic health disparities of all countries in the developed world. As a rural health advocate, I found the rural-urban inequalities along with embedded racism concerns to be most troubling. I know for a fact – as an example – that some of the worst – if not the worst – disparities from across the entire USA reside in rural places like Pine Ridge Reservation in South Dakota where the poverty level is 53.75%!! There is a clear need for more state-based as well as a national focus on health disparities generally as well as across rural areas throughout the nation. There are certain exemplary programs such as the Equitable Neighborhoods Initiative, sponsored by the University of Alabama that are working to equip communities to become more resilient to health disparities. Specialized programs in “rural” primary care and surgery such as those offered by my alma mater at the University of North Dakota School of Medicine and Health Sciences are also needed across the nation. With much of the rural workforce dependent upon the Boomer generation, we can anticipate a significant growth in health disparities unless more focus and support are given to solving the geographic disparities problems. It’s a problem in need of a solution… 

Double Kudos for The Centers for Medicare and Medicaid Services (CMS) – One of the issues that CMS has been grappling with ever since the launch of ObamaCare is how best to create “value” in the health care delivery chain. It’s an issue that I believe can best be handled through the effective deployment of “primary care coordination” across the spectrum of care delivery. But, then again – I’m a Family Physician by training so you would expect me to be an advocate for primary care (= Family Practice, General Internal Medicine, Pediatrics, Gynecology Generalists [my definition]). CMS is finally moving forward with plans to implement value-based care delivery. Under the ObamaCare program, CMS set a goal of getting 100% of Medicare beneficiaries into “value-based arrangements” by 2030. While movement was on hold for four years, it picked up again when the Biden Administration moved to engage in a “strategic refresh“. Under the initiative, CMS is taking a hard look at the status of initiatives established under Obama and determining which directions to support going forward. CMS has been pushing internally to kick-start a focus on the value-based care delivery model. As a result, CMS in June announced the launch of a major new initiative, Making Care Primary (MCP). The focus of CMS efforts is to: "improve care management and care coordination, equip primary care clinicians with tools to form partnerships with health care specialists, and leverage community-based connections to address patients' health needs…" Good goals from my perspective. Importantly, the initiative includes a strong focus on the Social Determinants of Health (SDOH) which have been shown to represent 80% of the cost of care following discharge from hospital. In essence, it’s about transportation, nutrition, home care support, in-home medication management and other considerations. The MCP model will be deployed over the course of the coming decade to allow primary care practices time to develop the capacity and infrastructure to appropriately deploy and coordinate value-based care delivery services. In fact, one of the areas of focus is on the state Medicaid programs which are moving forward with a variety of initiatives focused on value-based care delivery. For more information on the CMS initiatives, check out an interview with John Barkett, Managing Director for Healthcare at the Berkeley Research Group.  

New Study on Private Equity Healthcare Investments = Not Good! – A recent study published in The British Medical Journal documented the upsides and downsides derived from the involvement of private equity (PE) ownership in healthcare operations. The study was not complimentary and highlighted the “harmful impacts” of PE from payers to providers to patients. It included a meta-analysis of 55 prior studies related to healthcare PE ownership. In sum, the downsides outweighed the upsides of PE ownership, particularly in institutional settings such as hospitals and nursing homes. The reason it’s an important study for consideration is that PE ownership in healthcare has grown precipitously over the last several years and is projected to experience further growth in the coming years. The authors of the study suggested that due to the growth in health care, PE investments were “…warranting surveillance, reporting and possibly increased regulation.” This is an issue that deserves every health care leader’s attention. It is especially important in follow-up to the prior Consolo Indicium note on “value-based care delivery”...

Some Important Stats On The Field of Medicine – The Federation of State Medical Boards recently completed its 7th biennial census of physicians in the USA. The current count as of 2022 was just over one million physicians licensed to practice in the USA with 89% holding a Doctor of Medicine (MD) degree and 11% hold a Doctor of Osteopathic Medicine (DO) degree. Some other important stats include the following:

  • The number of physicians who are board certified in their respective specialty has increased from 77% (2010) to 85% (2022) – a tribute to the specialty societies in emphasizing the need for board certification.
  • On the downside the physician pool is getting a bit older (ahem – like me 😊) with the mean age of 51.9 years (2022) compared to 50.7 (2010).
  • However, such a small increase in the media age does not quite accurately portray the profession. Why? Because over that same period there was a 54% increase in the number of physicians aged 60 years and older. This portends a very significant shortage of physicians in the not-too-distant future as the population continues to increase.

On the upside, the presence of women in the physician workforce has increased fairly dramatically from 30% in 2020 to 37% of the total physician pool in 2022 – a fact that I believe has been a very positive force for the profession.

The Microbiome and Brain Health – As a follower of brain health research, I found the research presented at the Alzheimer’s Association International Conference in Amsterdam last month to be quite interesting. There is a growing body of research demonstrating a direct link between our biome and our projected brain health. For example, one study found that chronic constipation was tied to declining cognitive abilities with the loss of up to three years of aged living for those who were so affected. Specifically, constipation resulted in a depletion of bacteria that produce butyrate which creates byproducts supporting the gut barrier and prevent the entrance of bad bugs! In another study, low levels of neuroprotective gut bacteria, Butryricicoccus and Ruminococcus, were associated with elevated levels of Alzheimer’s disease. There is clearly a growing body of evidence related to the gut microbiome and our cognitive capabilities over time. Perhaps this accounts for those population groups (e.g. certain Japanese populations) that have exceptionally good cognitive function far above the average based on simple dietary differences. I suspect we will be finding over the next decades that dietary intake and microbiome function have far more to do with our mental sustainability than is currently known. Meanwhile, eat six cups of fruits and vegetables every day!

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