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The Keckley Report

Is it Time to Re-think Self-Care?

By March 21, 2022March 1st, 2023One Comment

Self-care is the bridge to healthcare value, but crossing it will be challenging for the U.S. health industry. It’s key to reducing the progression of chronic conditions, avoiding unnecessary hospitalization, improving workforce performance and lowering healthcare costs. But it’s not taken seriously as a solution by policymakers, physicians and others who discount its potential. Is that likely to change? The jury’s out but It’s getting fresh attention.

The Concept of Self Care

Self-care has been defined as “any necessary human regulatory function which is under individual control, deliberate and self-initiated.” Essentially, it involves actions taken by individuals to maintain their health and wellbeing and/or treat a condition without direct intervention with providers. It includes lifestyle choices, habits and purchases by individuals that directly impact their quality of life and how choices of hospitals, physicians, therapies and courses of care are made.

Health services researchers have studied self-care comparing attitudes and behaviors based on a group’s socio-economic circumstances, diagnoses, health status and propensity to be engaged decision makers in their own care. They’ve concluded that appropriate self-care is an uphill climb for the majority of Americans—not just those in lower socio-economic cohort most impacted by social determinants of health—because healthcare is complicated and overall health literacy is low.

Self-care is not a mainstream concept in U.S. healthcare. Physicians and hospitals associate it with patient adherence and complaints. Health insurers associate it with plan selection, provider utilization and enrollee customer service. Drug manufacturers think about prescriber interactions with users, brand preferences and medication adherence. But self-care is not foundational to how U.S. healthcare system operates despite its potential to lower costs and improve care.

The Reality of Self Care

Direct out of pocket spending by consumers including their insurance premiums was 9% of total health spending ($388.6 billion) in 2020–down 3.7% from after an increase of 4.4% to $403.7 billion in 2019. When combined with state and federal indirect spending i.e. Medicare payroll taxes, et al, households spent $1.078 trillion for their healthcare—26% of total health spending in 2020. Since CMS forecasts health spending will increase 5.4% annually through 2028 and a Medicare funding shortfall starting in 2026, it is likely direct and indirect costs for the health system will increase dramatically for the next decade. It’s further complicated by three trends:

·        Higher out-of-pocket obligations for insured consumers.

·        Increased dissatisfaction with the performance of the U.S. health system overall: 59% favor a complete overhaul to address affordability, access and equity.

·        Growing demand for cost-effective chronic care management programs that depend on self-care.

However, self-care remains a side show for many in healthcare. Though self-care products (over-the-counter remedies, dietary supplements, food as medicine, publications, and self-monitoring devices, et al) is a $150 billion market and self-care services not covered by insurance (weight management, optometry, prophylactic dentistry, fitness, health counseling, wellbeing programs, et al ) constitute a significant market, they’re relatively inconsequential to bigger pieces of the pie involving facilities, technologies, specialty drugs and precision medicines.

Access, equity, workforce resilience and price controls for drugs, insurers and hospitals are the system’s immediate focus. Self-care is simply not a priority right now.  

My take:

Friday, I had the opportunity to speak to the Consumer Health Product Association’s Self-Care Leadership Summit in Florida where self-care for OTC, dietary supplements and self-monitoring devices is their focus.

They talk about consumer preferences, branding, omnichannel strategies and price elasticity; they don’t talk about patients, coverage and patient care. Clearly, the healthcare industry can learn from the self-care industry and the self-care world seems destined to marry the traditional healthcare financing and delivery world. In my view, neither is ready nor are policymakers and regulators who’ll author their rules of engagement.

Regardless, if chronic diseases and lifestyle habits continue to absorb the health system’s resources, self-care must be taken more seriously. It’s time to rethink self-care in our clinical education programs for providers, in our hospital board rooms and medical group meetings, in our schools, workplaces and homes. And it’s time to shape health policies around a tools, not rules model and invest in a coordinated program that’s likely to be a 20-year effort.

The pandemic has awakened the notions of consumer choice, science, misinformation, disinformation and self-care. It’s an important context for fueling the self-care engine in the U.S. health system. Left in idle, the system is not sustainable.


P.S. Today begins the Senate Judiciary Committee confirmation hearing for U.S. Supreme Court nominee Ketanji Brown Jackson who currently serves as a judge on the United States Court of Appeals for the District of Columbia Circuit. President Biden nominated her to that post in April 2021 and the Senate confirmed her with a 53-44 vote on June 14, 2021. The ‘22-‘23 term of the court is likely to address critical issues in healthcare.



International Self Care Foundation

Global Self Care Federation Nyon, Switzerland

National Health Expenditures CMS

Alexander Segall; Jay Goldstein (1998). “Exploring the Correlates of Self Provided Health Care Behaviour”. In Coburn, David; D’Arcy, Alex; Torrance, George Murray (eds.). Health and Canadian Society: Sociological Perspectives. University of Toronto Press. pp. 279–280. ISBN 978-0-8020-8052-3.

Regulatory Insights

Becerra lays out 2022 HHS agenda: Nearing the one-year anniversary of his confirmation and facing criticism of his modest role in addressing Covid, drug prices, et al, Health and Human Services Secretary Xavier Becerra laid out his priorities for 2022:

·        Additional Covid Relief funding

·        Reducing Medicare Advantage overpayments

·        Physician payment reform

·        Medicare Part B Premium Reductions

·        Enforcement of No Surprises Act

·        Funding for expanding Health Exchange enrollment

US Department of HHS March 19, 2022

Grassley call on FTC to investigate PBMs: Following the Federal Trade Commission’s decision last month to not investigate pharma middlemen, or pharmacy benefit managers, Iowa Republican Sen. Chuck Grassley sent a letter last week to FTC chair Lina Khan, urging the commission to examine how the PBM industry affects patients’ out-of-pocket expenses. The top three PBMs — run by CVS/Caremark, OptumRx and Express Scripts — control 77% of the market.

“Grassley to FTC: Investigate the role of PBMs on out-of-pocket costs” Endpoints News March 14, 2022

Veterans Affairs proposed to close hospitals in MA, NY, OH, add 80 ambulatory sites: The VA system serves 9 million veterans in 171 medical facilities and 1,000 outpatient sites. Medical centers in Northampton, Mass.; Brooklyn, N.Y.; and Chillicothe, Ohio, would close under the proposal, with their services shifted to other VA facilities. Nearly 400,000 more veterans also would have access to outpatient specialty care within 60 minutes, according to the report.

“VA Recommendations to the AIR Commission” US Dept of Veterans Affairs March 14, 2022

Med PAC: Medicare Advantage Plans collected $12 billion in “excess payments” in 2020:  According to the report by the Medicare Payment Advisory Commission, or Med PAC, released last Tuesday, payments to Medicare Advantage plans for extra benefits have increased by 53% since 2019 “yet we have no data about their use nor information about their value.” Related: In 2019, a Kaiser Family Foundation study found Medicare overpaid MA plans $7 billion more than the cost of caring for those beneficiaries in traditional Medicare in 2019 and an investigation by the HHS Office of the Inspector General for the U.S. found that the practice resulted in overpayments of $6.7 billion in 2017.

Related: The number of beneficiaries in employer-sponsored Medicare Advantage plans increased from 1.6 million in 2008 to more than 5 million last year, according to CMS. With each Advantage member, the government spends 4% more than it does for someone in the traditional fee-for-service program, according to the Medicare Payment Advisory Commission, which advises Congress.

“Medicare Watchdog Warns of $12 Billion in Excess Payments” Bloomberg March 15, 2022

Census Bureau: household income up in 48 states: Last Thursday, U.S. Census Bureau released new statistics from the 2016–2020 American Community Survey (ACS) 5-year estimates. Highlights:

  • U.S. median household income increased to $64,994 when compared to the 2011–2015 ACS 5-year data adjusted for inflation increasing in 48 states and the District of Columbia, decreasing in one state (Alaska), and was not statistically different in one state (Wyoming) and Puerto Rico.

·        Of 122,354,219 households in the U.S., 15,312,497 are low the poverty level, 13,892,407 receive food stamps, 31,391,642 include one or more persons with a disability

  • From 2011–2015 to 2016–2020, the overall poverty rate decreased from 15.5% to 12.8%. Across these two time periods, the poverty rate decreased in 49 states, the District of Columbia and Puerto Rico, while the change in the poverty rate in Alaska was not statistically significant. No state had an increase in poverty.

2016–2020 American Community Survey

Fed raises interest rates, revises guidance on economic recovery: Last week, the Federal Open Market Committee increased the federal funds rate to a range of 0.25% to 0.5%, the first rate rise since 2018. The median policymaker expects the rate to be 1.9% at the end of the year, implying a total of 7 rate hikes this year, and 2.8% at the end of 2023—highest since 2008. Other notable guidance:

·        Prices are expected to increased 4.3% through 2022, up from the 2.6% pace they forecasted in December.

·        Inflation will be slightly higher. While the projection shows price growth cooling from current levels, the 2022 average still sits uncomfortably above the Fed’s 2% target.

·        Gross domestic product is now expected to average 2.8% this year– down from the previous estimate of a 4% gain. The following two years are expected to show GDP growth of 2.2% and 2%, respectively, both unchanged from the December estimates.

Context:  In the fourth quarter of last year households had about 36% more liquid assets, such as bank deposits, than they did in the fourth quarter of 2019. Inflation rose 7.9% in February from the previous year, the fastest pace in 40 years, according to the Labor Department. Gasoline prices were up 38% on the year.

 “Fed Raises Interest Rates for First Time Since 2018” Wall Street Journal March 17,

“U.S. Retail Sales Grew 0.3% in February” Wall Street Journal March 17, 2022

USPTF says evidence to encourage eating disorders screening incomplete: eating disorders (e.g., binge eating disorder, bulimia nervosa, and anorexia nervosa) are psychiatric conditions defined as a disturbance in eating or eating-related behaviors that impair physical or psychosocial functioning. According to large US cohort studies, estimated lifetime prevalence for anorexia nervosa, bulimia nervosa, and binge eating disorder in adult women are 1.42%, 0.46%, and 1.25%, respectively. Eating disorder prevalence ranges from 0.3% to 2.3% in adolescent females and 0.3% to 1.3% in adolescent males. Eating disorders are associated with short-term and long-term adverse health outcomes, including physical, psychological, and social problems.

In its review last week, the US Preventive Services Task Force (USPSTF) concluded evidence is insufficient to assess the balance of benefits and harms of screening for eating disorders in adolescents and adults. The evidence is limited and the balance of benefits and harms cannot be determined.

Screening for Eating Disorders in Adolescents and Adults US Preventive Services Task Force Recommendation Statement US Preventive Services Task Force JAMA. 2022;327(11):1061-1067. doi:10.1001/jama.2022.1806

States considering associate physician licensing: Assistant/associate physicians are medical school graduates who have not yet completed residency training. Licensure is being considered in Missouri, Arizona, Arkansas, Kansas, Utah. and Virginia to address primary care shortages. Trade groups representing nurse practitioners oppose the legislation believing their members better suited, and medical societies argue better pay and more PC residencies a better route.

Missouri Tried to Fix Its Doctor Shortage. Kaiser Health News  March 17, 2022

USPTF says evidence to encourage eating disorders screening incomplete: eating disorders (e.g., binge eating disorder, bulimia nervosa, and anorexia nervosa) are psychiatric conditions defined as a disturbance in eating or eating-related behaviors that impair physical or psychosocial functioning. According to large US cohort studies, estimated lifetime prevalence for anorexia nervosa, bulimia nervosa, and binge eating disorder in adult women are 1.42%, 0.46%, and 1.25%, respectively. Eating disorder prevalence ranges from 0.3% to 2.3% in adolescent females and 0.3% to 1.3% in adolescent males. Eating disorders are associated with short-term and long-term adverse health outcomes, including physical, psychological, and social problems.

In its review last week, the US Preventive Services Task Force (USPSTF) concluded evidence is insufficient to assess the balance of benefits and harms of screening for eating disorders in adolescents and adults. The evidence is limited and the balance of benefits and harms cannot be determined.

Screening for Eating Disorders in Adolescents and Adults US Preventive Services Task Force Recommendation Statement US Preventive Services Task Force JAMA. 2022;327(11):1061-1067. doi:10.1001/jama.2022.1806


ACS Survey: 51% of cancer patients have medical debt: Findings of the American Cancer Society Cancer Action Network Survivor Views survey of 1218 cancer patients conducted February 9 through 23, 2022:

·        73% are concerned about their ability to pay current or future costs of their care and 70% are worried about incurring medical debt due to their cancer care and treatment.

·        53% of debt-holders faced collections and 46% saw their credit score negatively impacted.

·        45% of those who have had medical debt have delayed or avoided medical care for serious issues as a result, and 62% have delayed or avoided medical care for minor issues, while half have sought the least expensive treatment options due to their debt.

American Cancer Society

Health Insurance

Study: alternative payment schemes associated with lower hospital utilization in MA: In a study population of 489,796 MA beneficiaries, value-based payment was significantly associated with lower acute care use. Compared with FFS, beneficiaries cared for under 2-sided risk models had lower rates of hospitalizations, observation stays, and ED visits. For all outcomes, there was no significant difference in acute care use between beneficiaries cared for under upside-only risk models and FFS. The association between value-based payment and decreased acute care use was most pronounced for measures of avoidable acute care use (15.6%) vs.  4.2% for all-cause hospitalizations.

“Analysis of Value-Based Payment and Acute Care Use Among Medicare Advantage Beneficiaries” JAMA Netw Open March 17, 2022;5(3):e222916. doi:10.1001/jamanetworkopen.2022.2916

AHIP: supplemental coverage in Medicare increasing: Background, in 2020, the traditional Medicare program had a $1,408 deductible per benefit period for inpatient hospital care (Part A) and coinsurance beginning with day 61 of hospitalization. Part B required 20% coinsurance for outpatient and physician care after an annual deductible of $198.  The traditional Medicare program does not have a limit on enrollees’ potential out-of-pocket costs. As a result, in 2020 when the proportion of Medicare fee-for-service beneficiaries with Medicare supplement increased from 38.2% to 38.7%. Medicare enrollees with Medicare Supplement coverage were three times less likely to have problems paying medical bills compared to enrollees without Medicare Supplement policies. (Only 4% of enrollees with Medicare Supplement coverage reported having difficulty paying medical bills in the last 12 months vs. 12% of FFS Medicare enrollees without Medicare Supplement coverage).

“The State of Medicare Supplement Coverage” AHIP March 2022


CDC: BA-2 variant now 23% of new Covid infections: That’s up from 10% the week prior. Since January, Omicron has made up virtually all new infections in the U.S. Like in many countries abroad, most cases in the U.S. had been caused by a sub-lineage of Omicron known as BA.1. But while both BA.1 and BA.2 can be traced back to some of the earliest samples gathered of Omicron, BA.2 has only recently begun to climb in prevalence.


Study: mental health visits to EDs spiked during the pandemic: In this cross-sectional study of 107,761, 319 eligible ED mental health visits in 2352 facilities by adults 18-64 years of age between January 1, 2019, to August 14, 2021 involving 3 waves of the pandemic:

Conclusion:Results of this cross-sectional study suggest that EDs may have increases in MH-related visits after COVID-19 surges, specifically for young adults and individual racial and ethnic minoritized subpopulations.”

“Changes and Inequities in Adult Mental Health–Related Emergency Department Visits During the COVID-19 Pandemic in the US” JAMA Psychiatry March 16, 2022. doi:10.1001/jamapsychiatry.2022.0164

Survey: harassment of public health officials: Based on a national survey of local health departments (LHDs) in the United States conducted from March 2020 to January 2021:

At least 1499 harassment experiences were identified by LHD survey respondents, representing 57% of responding departments. We also identified 222 position departures by public health officials nationally, 36% alongside reports of harassment.

Pandemic-Related Workplace Violence and Its Impact on Public Health Officials, March 2020‒January 2021 American Journal of Public Health March 17, 2022


Bloomberg: Travel nursing industry will grow even as pandemic subsides: Travel nursing industry revenue tripled to an estimated $11.8 billion in 2021 from $3.9 billion in 2015, according to Staffing Industry Analysts. Though the supply of nurses continues to increase, travel nursing is positioned for growth as nurses face burnout, expanded work options and competition-induced wage increases.

·        There are more than 5 million nurses in the U.S., of which 4.2 million are registered nurses, according to the National Council of State Boards of Nursing.

·        Average monthly postings for open travel nursing jobs rose 15% in January from a year earlier, according to ZipRecruiter Inc.. 

·        Interest in travel nursing continues to grow, with job searches more than five times pre-pandemic levels, according to data from Indeed (951.2 per Mil searches in February 2022 vs. 1200/Mil in January and 165/Mil in January 2020). Wages for travel nurses have surged during the pandemic to as high as 3.4 times that of regular full-time nurses in January 2021, according to ZipRecruiter.  

·        Meanwhile, hiring for staff nurses is falling across the U.S., dropping 3.2% in February compared with a year earlier, according to the Labor Department.

·        National Council of State Boards of Nursing, 192,000 nurses passed the RN exam in 2021 vs.182.6 in 2020– increasing annually from 2017 from 166.2

“Hospitals to Lean on More Expensive Travel Nurses Even After Covid” Bloomberg March 15, 2022

Public Health

CDC: tobacco use down, lowest since 1965: Per the new CDC report, overall tobacco use has fallen among U.S. adults but almost 1 in 5 people (47 million) still smoke cigarettes, cigars, or pipes; puff on e-cigarettes; or dip into smokeless tobacco including 31 million who smoke cigarettes. The 2020 National Health Interview Survey data show a drop from 2019, when the tobacco rate was 20.8%. At 19% a year later, that reflects the lowest prevalence recorded since 1965 (when it was 42%). But rates are uneven, with higher tobacco use in rural areas; among non-Hispanic American Indian/Alaska Native adults; individuals with less education and income; people who identify as lesbian, gay, or bisexual; those who are uninsured or have insurance through Medicaid; people with a disability; or individuals who regularly experience anxiety or depression.

Cornelius ME, Loretan CG, Wang TW, Jamal A, Homa DM. Tobacco Product Use Among Adults — United States, 2020. MMWR Morb Mortal Wkly Rep 2022;71:397–405. DOI: icon.

Study: Hospitalists increase hospital encounters, severity:  In this cohort study of 4 071 241 Medicare fee-for-service beneficiaries treated in hospitals between 2009 and 2018, hospitalists billed a significantly higher proportion of their initial, subsequent, and discharge encounters of Medicare beneficiaries as high-severity compared with non-hospitalists, even after accounting for patient complexity, and this gap is growing over time. Findings:

·        The number of hospitalists grew by 76%, from 23,390 in 2009 to 41,084 in 2018, whereas non-hospitalists decreased by 43.6% (53,758 to 30 289).

·        The proportion of encounters performed by hospitalists increased for the initial hospital encounters (46.3% to 76%), subsequent encounters (46.8% to 76.7%), and discharge encounters (46.1% to 78.5%) over the 10-year period.

·        The proportion of high-severity billing across the hospital, subsequent, and discharge encounters was consistently higher among hospitalists relative to non-hospitalists across all years. Compared with the trends for non-hospitalists, the proportion of high-severity billing grew by 0.46% per year for initial encounters, 0.38% per year for subsequent encounters, and by 1.1% per year for discharge encounters among hospitalists.

Trends in High-Severity Billing of Hospitalized Medicare Beneficiaries Treated by Hospitalists vs Non-hospitalists JAMA Health Forum March 18, 2022;3(3):e220120. doi:10.1001/jamahealthforum.2022.0120

Urban Institute: 16 million could lose Medicaid coverage as PHE ends: From February 2020 to September 2021, enrollment in Medicaid and the Children’s Health Insurance Program increased by 19.1% reaching 84.8 million as Relief Funds to states allowed temporary enrollment in Medicaid. When the Public Health Emergency (PHE) ends, the Urban Institute estimates as many as 15.8 million could lose coverage by September creating an administrative challenge for states (re-enrollment) and increased bad debt for providers.

“What Will Happen to Medicaid Enrollees’ Health Coverage after the Public Health Emergency?” Urban Institute March 9, 2022

Expanded scope of practice for Dental therapists associated with increased access to oral care: Currently, 13 states have expanded their dental workforce by adopting use of dental therapists. In this cross-sectional study of 2,613,716 adults, authorizing dental therapists to provide direct prophylactic oral care was associated with an increase in dental care use among low-income adults. In subgroup analysis, authorizing dental therapists was associated with an increase in dental visits for White adults, but no significant change in use was detected for other racial and ethnic groups.

Comparison of Dental Care Visits Before and After Adoption of a Policy to Expand the Dental Workforce in Minnesota JAMA Health Forum March 18, 2022 2022;3(3): e220158. doi:10.1001/jamahealthforum.2022.0158

UnitedHealth Group challenges Justice Department ruling on Change acquisition: On February 24, the DOJ filed a lawsuit challenging the $13 billion acquisition alleging the transaction would harm competition in commercial markets, make coverage more costly for millions of people and give UnitedHealth too much power in electronic data transactions. On March 17, UHG issued its response saying the lawsuit is based on theories with “no basis in fact and law.”

“The government’s case rests entirely on speculation and theories unsupported by any past conduct…Optum’s business model and financial success is dependent on providing products and services to external customers, not just UnitedHealthcare”

The Justice Department argued the acquisition would give UnitedHealthcare a monopoly in claims-editing technology, but UnitedHealth said it has agreed to divest the business and plans to ink a purchase agreement in “a matter of weeks.”

“Benefits of Combination with Change Healthcare”

Altarum: health price inflation lower than other sectors: Per Altarum’s March report:

·        Overall, Health Care Price Index (HCPI) growth slowed in February, falling to 2.1% year over year from 2.4% a month prior, keeping it near the average growth seen over the past 12 months.

·        Health care price growth remains much lower than expected given economywide inflation continues to increase—February CPI growth was 7.9% and PPI growth was 10.0%, both faster than a month before.

·        Price growth fell for most major health care service categories—with hospital, physician, dental, home health, and nursing home care growth slower than January. Prescription drug price growth increased in February.

·        Growth in prices paid by private insurance for health care services fell in February to 3.1% year over year, but remained above Medicare and Medicaid price growth, at 1.1% and 1.9% respectively.

Altarum March 15, 2022

Primary Care

Commonwealth: Primary care in US less accessible than majority of developed systems: Per the Commonwealth Fund report Primary Care in High-Income Countries: How the United States Compares comparing U.S. PC to PC in 10 high income countries:

  • The U.S. ranked #10 of 11 on the percentage of adults who have a regular doctor or somewhere to go for primary care (89%)

  • The U.S. ranked last on the percentage of adults who have a longstanding relationship (5-year) with a primary-care provider (43%)

“Primary Care in High-Income Countries: How the United States Compares” Commonwealth Fund March 15, 2022

Private Investing in Healthcare

Pitchbook: Food tech investments soared in 2021: After the record $171.7 billion in deal value in 2020, 2021 saw a staggering $302.7 billion tally across 6,344 expansion-stage transactions. Q1 2021 alone produced just over 1,700 completed financings, the largest single-quarter tally of volume on record. Many sectors set significant records in terms of financing volume and value, but one of the key segments with the largest year-over-year increase was foodtech. Buoyed by multiple factors, foodtech’s deal value more than doubled, from $6.0 billion in 2020 to $13.1 billion in 2021, while financing volume also grew at a healthy rate. Hedge funds and sovereign wealth funds participated in 45% of all foodtech deal value in 2021 ($5.9 billion). Notably, valuations have risen, with the median expansionstage figure notching an all-time high of $130.0 million in 2021. As deal flow grew—with transactions sized $50 million+ nearing 30% of all volume in 2021—an important new trend is the steady increase in nontraditional investor participation in some of the larger deals.

Road to Next Deloitte-Pitchbook

VC Digital health funding hits record high in 2021: According to Digital Health Business & Technology’s Q4 2021 report, a record $30.7 billion in venture capital funding for digital health companies was invested in 2021– 107% over 2020 funding ($14.8 billion)—in 2020. A total of 2,286 investors participated in digital health funding in 2021, compared to 1,600 investors in 2020.  Other findings:

·        To date in 2022, VC’s have invested $5.2 billion in digital health companies (65 deals).

·        In 2021, the average deal in Q1 was $43.2 million vs. $32.6 million in 2022 YTD deals.

·        Of the 18 digital health companies that went public on an American stock exchange in 2021, only 2 (Signify Health and Owlet) have gained value from their initial price. The other 16 have seen a decrease from their initial stock price. 

Digital Health Funding and M&A Report – Q4 2021


Nursing Homes

Study: nursing home average staffing measures do not predict quality: Average staffing measures are a focus of nursing homes’ quality assessments and reporting though they mask daily variation in staffing. This quality improvement study of 13 339 nursing homes found that daily variation of staffing was significantly associated with the 5-Star Survey and Quality Measures rankings. There was little agreement between the variation and the average staffing measures on quality decile rankings of nursing homes. “These findings highlight the importance of reporting daily variation in staffing to improve understanding of the relationship between staffing and quality.”

“Daily Variation in Nursing Home Staffing and Its Association With Quality Measures”JAMA Netw Open March 14, 2022;5(3):e222051. doi:10.1001/jamanetworkopen.2022.2051


One Comment

  • M.L. says:

    There may be some foundational issues with the United States nutritional guidelines and food options that contribute to chronic health concerns. These are often overlooked and not connected with general population health management.
    Unhealthy and inexpensive processed foods with added sugars are a catalyst for chronic disease which is symptomatically managed by pharmaceuticals. Good health is not good/profitable for healthcare economics.