Natalie Spicyn: Unionizing Clinicians

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This week we are joined by Natalie Spicyn, an internist and pediatrician at Chase Brexton, a Federally Qualified Community Health Center in Baltimore. Like all FQHCs, Medicaid patients are a large portion of the Chase Brexton payor mix, but the clinic also provides specialized care for a large and active LGBT and HIV positive community in the city.  Last year, caregivers and administrators faced conflict regarding proposed workflow, volume, and compensation restructuring. Several employees were terminated during early efforts at unionization; ultimately, clinicians voted to unionize and attempt collective bargaining.  Natalie published an op-ed in the Baltimore Sun during this tumultuous period, and joins us to talk about her experiences with unionizing, fair compensation practices in primary care, and how all of this affects patient care.

Photo: Rally outside Chase Brexton Health Care in Baltimore, Maryland, on Aug. 19, 2016. Photo: Jay Mallin, jay@jaymallinphotos.com, Courtesy of 1199 SEIU

Matt Broaddus: What are Medicaid Block Grants?

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This week we are joined by Matt Broaddus to talk about block granting Medicaid, which is a major health policy change that the Trump administration plans to pursue in the coming months. Matt is a Research Analyst in the Health Division at The Center on Budget and Policy Priorities, a non-partisan research and policy institute in Washington DC. His policy, research, and analytical work is conducted in the areas of Medicaid and the State Child Health Insurance Programs.

We start with an overview of the Medicaid program, the largest insurance program in the US. We touch on the possible benefits of block granting (19:00), and how it may affect other industry stakeholders such as health systems, hospitals, community health centers, and insurers that offer Medicaid managed care products (23:20). Lastly we discuss another block granted program, CHIP and why many see it as a successful block grant program (29:00), and one other suggestion that has been made for Medicaid reform, per-capita funding (32:45).

You can find the article we mentioned by Sara Rosenbaum here, as well as some additional resources on block grants from Kaiser Health News and The Commonwealth Fund.

If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

Photo: President Lyndon B Johnson surrounded by supporters and advisors signing Medicare into law.

Journal Club: Powers et al – Non-Emergency Medical Transportation; Delivering Care in the Era of Uber and Lyft

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This week we’re excited to bring you a journal club episode, highlighting a study published in the September 2016 issue of JAMA by Brian Powers and colleagues Scott Rhinefort and Sachin Jain from Caremore Health, entitled NonEmergency Medical transportation, Delivering care in the Era of Lyft and Uber. Powers and colleagues report on their pilot study of Caremore Health patients utilizing Uber and Lyft for non-emergency medical transportation to and from appointments.

If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

Jessie Gaeta: SPOT – Supportive Place for Observation and Treatment

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Today our guest is Jessie Gaeta, the Chief Medical Officer of Boston Health Care for the Homeless Program. She is a leading advocate for supportive housing for chronically homeless individuals, and has led BHCHPs efforts in responding to the opiate use disorder and overdose crisis, which is what we discussed.

Dr. Gaeta and her colleagues found themselves confronting the reality of opiate overdose as the leading cause of death among Boston’s homeless individuals day after day on their campus. In reaction to this, Gaeta and her colleagues opened SPOT, or Supportive Place for Observation and Treatment – a space within their building where individuals can come after using to ride out a high while being monitored by a nurse for overdose, and for opiate reversal if necessary.

Photo: Jessie Gaeta, MD