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Showing posts from September, 2018

Rachettattating Nurses Physicians and Others Who Deliver the Care

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The corporate takeover of health care is more obvious with each passing day. The power goes with the trillions of health care dollars. Insurance corporations, drug corporations, and largest systems dominate. They can dictate the disposition of dollars. They can effectively prevent reforms, They can design legislation and programs that favor their interests. Generally this marginalizes dollars for patient care, dollars for the support of those who deliver the care, dollars for basic services, and dollars for most Americans most in need of care. In other words, health care has been redirected to care of the corporation.

Sadly much of the rhetoric that guides this transition claims to be focused on the patient and on better outcomes. This is clearly not the case. Journalists are often engaged in some new innovative intervention that has great promise - but that mostly requires more dollars for same or less outcomes. This is can even be termed value-based even when the outcomes stay the …

The CMS Contribution to the Devastation of Rural Health

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Searching on CMS and rural health is revealing. There are regular headlines with regard to reports and proposals and programs. The themes of innovation and quality grab the attention. But there has been a continued lack of progress where it matters most - in Rural Health Care and the Ability to Care
In the last decade even worse has been the case. The next decade seems to have the potential for devastation to rural health.


CMS says rural health needs major improvements in quality, 
but CMS leads the nation to pay too little resulting in half enough generalists and general specialists – those who provide 90% of rural services in the places with limitations of quality, outcomes, workforce, and access.
Quality and outcomes are actually about the situations, conditions, relationships, and environments as well as income, housing, jobs, education, and other social determinants. CMS contributes to lesser social determinants by designs that send 15% less to rural practices and 30% less to rur…