February 21st, 2017

Please keep in mind far-right wing global Wall Street pols CLINTON/BUSH/OBAMA now Trump have absolutely NO GOOD WILL towards any immigrant group being brought to America ---the goal is always to exploit those immigrant citizens while bringing down US standards of life. So, let's look at why a Wells Fargo and Johns Hopkins partnered in filling our US medical schools with Asian students.  TRUMP AND JOHNS HOPKINS are on the same team global Wall Street so Trump's decision does not work against a Hopkins' goal.

Medical Students - Non-U.S. Residents


FINANCIAL AID AVAILABLE FOR NON-US RESIDENT
MEDICAL STUDENTS
Financial aid funding is available to all current and newly admitted Non-US resident medical students.  Financial aid assistance will be provided in the form of institutional loan and/or scholarship.
To assist medical students from outside the United States to study at Johns Hopkins, Johns Hopkins Medicine International has provided funding to create the JHM International Scholarship Program.  Its aim is to help nurture the next generation of health care leaders, in addition to help reduce the financial burden that non-US resident student’s may face when trying to attain medical education funding. Click the link below for details on how to apply.


Applying for Financial Aid for Non-U.S. Resident Medical Students
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These several years of Obama and Clinton neo-liberal Congress giving us the raging Wall Street global health reform AFFORDABLE CARE ACT saw billions of dollars spent in education and bringing foreign medical workers to US cities deemed Foreign Economic Zones under the guise of SOME KIND OF LABOR SHORTAGE OF US WORKERS----as is said OVER AND OVER AND OVER.  What Obama and Clinton neo-liberals were doing was POSING LEFT SOCIAL DEMOCRATIC filling what would never remain open low-income health clinics, low-income hospitals and public nursing and home care with immigrant graduates from medical training here in the US.  Here in Baltimore our universities soared with these foreign medical students and they are largely the force behind immigrant protests against Trump.  Since Obama and Clinton neo-liberals NEVER INTENDED for low-income health care to exist---they were simply removing low-income from our major hospitals and doctor's care------Trump is simply ending that POSING and as was always intended these foreign medical students and professionals will now go back overseas to work in global health corporations being built in Foreign Economic Zones in their nations ---working for global Johns Hopkins et al.

Remember---the only access to health care for US low-income----working class will be TELEMEDICINE-----that means those foreign students and professionals returning to South Pacific and Asian Foreign Economic Zones can be those GLOBAL TELEMEDICINE DOCTORS, NURSES, NURSE PRACTITIONERS from overseas.  Obama and neo-liberals were simply funding and providing training space here in America with US taxpayer money that used to fund our Federal Student Loan programs for ALL AMERICANS.

This article written by GLOBAL KAISER----partnered with JOHNS HOPKINS speaks to this---and we can believe and we are shouting to our immigrant students caught in this----

KAISER AND HOPKINS IS NO FRIEND OF ANY IMMIGRANT----WHETHER WHITE COLLAR PROFESSIONAL OR BLUE COLLAR TRADES----

What Trump is doing is MOVING FORWARD ------

Hospitals, Politics, Kaiser
Trump’s immigration ban imperils some medical residency programs


By Carmen Heredia Rodriguez
1 Comment / Feb 2, 2017 at 12:11 PM



President Donald Trump’s executive order on immigration, which sparked protests abroad and in the U.S., is also raising fears about the impact on international medical students vying for training programs at U.S. hospitals, as well as young doctors in training from affected countries who are already working here.

Medical residency assignments will be announced in six weeks. The Association of American Medical Colleges, which represents medical schools and teaching hospitals, has identified 260 applicants who could be affected.


In a statement Monday, the AAMC asserted the nation’s need for foreign physicians to address the growing doctor shortage and maintain the U.S. as a “global leader” in medical innovation. The organization urged the Trump administration to “carefully consider the healthcare needs of the nation.”


Atul Grover, executive vice president at the AAMC, said the immigration policy’s effect on international medical graduates remains uncertain. Although the ban potentially affects a fraction of the nearly 31,000 people who are placed in residencies, he said he worries the executive order will cause disruption for the students and people whom they could help.


“These are doctors. They could be exceptional practitioners and I don’t know if you want to stop them from coming here and serving their patients,” Grover said.
Dr. Clarence H. Braddock III, a professor and vice dean at UCLA’s medical school, acknowledged concerns about the prospects for some international students following the Trump administration’s order and said that it could discourage residency programs from offering positions to some candidates.
Trump signed an executive order Friday imposing a 90-day ban on travelers entering the U.S. from seven countries: Iran, Iraq, Libya, Somalia, Sudan, Syria and Yemen. The initiative also suspended refugees from entering the country for 120 days and indefinitely from Syria.



One Sudanese applicant, who asked not to be named for fear of impacting his residency placement, said the news was a shock.
“It’s very devastating,” he said. “Because you [are] born in an unfortunate situation, you have to pay the price for that.”
The 26-year-old grew up in a middle class home in Sudan and graduated with awards from the University of Khartoum in 2014. He said he studied for two years for  the U.S. Medical Licensing Examination, a series of four tests required for international medical graduates to secure a spot in a residency program. He traveled twice to the U.S. and twice to Dubai to take the exams. He estimates the cost of travel, study materials and exam registrations totaled upwards of $20,000.


Young doctors from these nations who have already secured a coveted U.S. training slot and are working in U.S. hospitals are worried about their futures. As a first-year internal medicine resident in South Dakota, Radowan Elnair, 27, who is also from Sudan, had heard rumors of a major legislative change coming, but didn’t believe it would happen.



“It all happened so suddenly,” he said.
Elnair has been in touch with his immigration lawyer to learn how the ban affects his legal status. He needs to extend his visa but is waiting until more details of the executive order are released. His attorney recommended against traveling overseas, so he has cancelled plans to visit his family in Sudan this year.
Elnair also is concerned about whether he can even complete his training in internal medicine. “No one knows what’s gonna be next,” he said.
The ban began at a critical point for medical students. The residency announcements set for March 17 mark the end of a long application process for thousands of domestic and international medical graduates. Students submit a list of their preferred residencies to the National Resident Matching Program. Hospitals review applicants and submit a list of their preferred candidates. The program uses computer technology to assign students to residencies.
Mona Signer, the president and CEO of the matching program, said in an email that her organization is still planning to move forward with the original date, but “no one knows the long-term effect of the Executive Order.” She also said it’s likely the immigration change will make program directors reluctant to rank international students among their preferred candidates for residencies.


On Wednesday, Dr. James L. Madara, the CEO of the American Medical Association, sent a letter to the administration saying his organization is “concerned that this executive order is negatively impacting patient access to care and creating unintended consequences for our nation’s healthcare system.” He specifically raised fears that the restrictions could affect medical students applying for residencies and international doctors seeking to practice in the U.S. “Guidance is urgently needed from the Administration to ensure the upcoming residency matching program in March 2017 does not leave training slots vacant and that all qualified IMG applicants can participate,” Madara said.


The Educational Commission for Foreign Medical Graduates, which is responsible for assessing international medical graduates’ qualifications for U.S. residencies, said Friday it was also “evaluating the potential impacts.”

International medical graduates already face an uphill battle to secure a residency, said Carl Shusterman, an immigration attorney in Los Angeles. Medicare funding for residencies have been capped since the 1990s, curtailing the growth of programs and increasing competition among applicants.


According to Grover, international medical graduates have about a 50-percent chance of securing a residency in the U.S. “There’s way more people applying to more residency positions than there are available,” Grover said.


The majority of medical residents enter the country using a J-1 visa, which is relatively easy to acquire but requires holders to leave after they complete their training.
Many of them, however, stay in the country after their residencies through the Conrad 30 program, which places doctors in medically underserved areas, said Shusterman.


Phil Miller, vice president of communications for the physician recruiting company Merritt Hawkins, said these physicians help fill the gaps in American medicine that domestic doctors alone cannot do.
“We are, I think, benefiting from their presence here,” Miller said. “They’re saving a lot of lives.”
Dr. Catherine Lucey, professor of internal medicine and vice dean for education at the University of California, San Francisco, noted that many international graduates that stay in this country end up choosing specialties that are facing shortages, such as primary care, and practicing in places in dire need of doctors, including many rural communities. “We have benefitted a lot as a profession from the hard work and contributions of international graduates in the U.S. healthcare workforce,” Lucey said. “As educators, we are concerned about the healthcare workforce that serves our most vulnerable patients.”


She said her facility is not directly impacted by Trump’s executive order because the medical school graduating class doesn’t include students who are from the affected countries and its residency program generally recruits students from U.S. medical schools.
Foreign doctors provide a vital lifeline for healthcare in the United States. About a quarter of doctors in the country were born abroad. And according to the AAMC, the United States faces a shortage of up to 94,700 physicians by 2025.


But for the medical graduates seeking to enter the country for their residencies, Shusterman said they have few legal options at their disposal. The American Civil Liberties Union filed a lawsuit against the ban. Individual doctors could file their own lawsuits, Shusterman said, but a resolution is unlikely to occur before they are to begin their residencies.

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BELOW IS THE PAGE FOUND----PLEASE LOOK

The only aspects of Affordable Care Act that looked to help our low-income---rural----seniors was this building of clinics staffed with more and more and more immigrant health care workers---professional and patient care staffing. From home health care to low-income community clinics to private emergency care corporations---we saw a growing immigrant labor pool. This is what GLOBAL CORPORATE WALL STREET MEDIA OUTLETS LIKE KAISER PERMANENTE touted as an Affordable Care Act SUCCESS!

Meanwhile left social Democrats knew there was never any intention of having all this access -----it was staged and these trained foreign workers will now go back to be our GLOBAL TELEMEDICINE ---gutted of funding MEDICAID FOR ALL----

So, the lower costs are going to be TELEMEDICINE provided by overseas doctors and medical staff working for Asian Foreign Economic Zone wages.

THIS IS WHAT MIKULSKI, SARBANES, CARDIN, CUMMINGS AND ALL MARYLAND POLS WORKED HARD TO INSTALL DURING AFFORDABLE CARE ACT.

Does a Republican doctor like Harris like all this? OF COURSE---IT IS ALL FAR-RIGHT WING GLOBAL WALL STREET HEALTH CARE FOR MAXIMIZING PROFITS AND MAKING A FEW EXTREMELY RICH.

'Andrew Peter "Andy" Harris (born January 25, 1957) is an American politician and physician who has been the U.S. Representative for Maryland's 1st congressional district since 2011. He is a member of the Republican Party and currently[when?] the only Republican member of Maryland's congressional delegation. Harris previously[when?] served in the Maryland Senate'.


COMMONWEALTH FUND

In the five years since the Affordable Care Act was passed, the nation's attention has shifted from the law's insurance market reforms and the bumpy rollout of healthcare.gov to the success of the marketplaces in covering millions of previously uninsured Americans. Far less attention has been paid to the parts of "Obamacare" that target problems with how health care is delivered and paid for, many of which become apparent when people receive their insurance card and seek out care.



These problems run deep and wide. For starters, there are the enormous costs of providing care in the United States, which place untenable burdens on patients and families, on employers, and on federal, state, and local government. Then there are the many Americans, disproportionately poor and minority, who are not getting the care they need to manage their health and avoid emergency rooms and hospitals. There are problems with communication and coordination among health care providers, compromising the quality of their patients' care and driving up costs still further. And there are the social ills, like poverty and unstable housing, that have an outsized effect on health yet all too often are left unaddressed.1

Health care providers and others interested in fixing such problems run into daunting obstacles. Chief among them is a reimbursement system that tends to reward physicians and hospitals who are treating patients with acute conditions rather than those who are focused on preventing those conditions, or slowing their progression. Finding technological solutions and funding to improve communication among clinicians, avoid the duplication of tests and services, and improve outcomes for patients is also a challenge--especially for safety-net institutions working on razor-thin margins.


The Affordable Care Act, or ACA, takes multiple, complementary approaches to reforming our health care system. Some of these are intended to boost primary care, so providers can focus more of their attention on the sickest "high need, high cost" patients who account for much of the nation's health spending. Others seek to change the way hospitals, physicians, and other providers are paid, to promote greater collaboration and prudent use of health care dollars.

As illustrated below, the law includes a vast array of reform initiatives. The stories that follow spotlight just a few.


How the ACA Aims for Better Care at Lower Cost

Holding Providers Accountable
for the Quality and Costs of Care


Paying health care providers for each and every test, procedure, or office visit—as is often the case in the U.S.—ends up rewarding the delivery of more and more services, often without regard to the benefit. And it goes a long way toward explaining why health care spending now consumes nearly 18 percent of the U.S. economy—twice the level seen in other high-income countries. Despite all the resources we devote to health care, as a nation we don't fare any better. Just slightly more than half of Americans, for example, receive the care recommended by national guidelines.2

Maria Montaño learned to control her diabetes with help from her health coach, Herval Hernandez, who works in tandem with social workers, nurses, and physicians to help patients better manage chronic and costly conditions. Many of the payment reforms in the ACA seek to reverse these incentives by rewarding providers who produce better patient outcomes at lower cost.


Maria Montaño, age 68, is part of the ACA's grand experiment to reshape health care in the U.S. She lives near McAllen, Texas, where the average cost of caring for a Medicare beneficiary was twice the national average. Montaño has had diabetes for 20 years. She lives alone, cannot read, and often has trouble taking her medications. Even though she had been getting her blood sugar level tested every few months, her condition began spiraling out of control last spring.


Things began to change for Montaño after her physicians at Donna Medical Clinic joined the Rio Grande Valley ACO. The ACO, or accountable care organization, is a network of 19 primary care practices located in the southernmost tip of Texas. The practices—some with just one or two doctors—banded together to participate in Medicare's Shared Savings Program, which allows providers to share in the savings they generate by keeping patients like Montaño healthy and out of hospitals and emergency departments. It was a gamble for the practices, because they opted to take on risk as well: if they failed to reduce costs for patients, they would have to pay significant penalties to the federal government. But taking on greater risk also made the practices eligible for greater financial rewards.


What is an ACO?

An accountable care organization (ACO) is an entity formed by providers—for example primary care physicians, hospitals, specialists, and nursing homes—that agree to work together and take responsibility for the quality and total costs of care for a designated patient population.

As of May 2014, there were 626 ACOs in U.S.*

To receive shared savings, ACOs must:

First report and later meet benchmark levels of performance on measures assessing patients' experiences, patient safety, care coordination, delivery of recommended preventive care, and control of chronic conditions.†
Keep total costs for designated patients below a target level.


*http://leavittpartners.com/2014/06/bridging-the-gap-pharmacists-in-accountable-care-organizations/

† http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/ACO-Shared-Savings-Program-Quality-Measures.pdf

The Donna Medical Clinic's strategy was to focus more resources on patients with high needs like Montaño. That meant longer office visits, not only with doctors and nurses but also with social workers and health coaches like Herval Hernandez, who spend time with patients explaining medications and ways to control diabetes through better nutrition.


Starting last June, Hernandez called Montaño at 8:00 a.m. every day to check on her and help her figure out how to time insulin doses. Once a week, Montaño's daughter also reported her mother's blood sugar levels to Hernandez. In less than five months, Montaño's health improved dramatically—with her levels of HbA1c, a measure of how well diabetes is controlled, dropping from 15.87 to 7.2. "He really cared about how I was feeling," Montaño says.


Rio Grande is one of 405 accountable care organizations in Medicare's Shared Savings Program.3 Some, like Rio Grande, are networks of individual physician practices; others are led by large group practices or by hospitals partnering with other providers, such as nursing homes.


To bring down spending, these organizations often focus on preventive care or on improving management of chronic conditions at home. Partners in an ACO are also encouraged to look for savings in their business operations. Could they negotiate better prices for supplies or medical devices? Could they turn to lower-cost staff, such as nurses and medical assistants, to provide care that doesn't require a physician?

Alan Kurose, M.D., Coastal Medical's president and CEO, talks with staff about their key role in improving care. "Every person who works at Coastal has an opportunity to touch the lives of our patients," he says.



The Centers for Medicare and Medicaid Services (CMS) offered loans to some physician-led and rural ACOs to help them get up and running. One of these is Rhode Island's Coastal Medical, a medical group with primary care practices across the state, which used the funds to hire additional staff and convene team conferences to review how complex patients are faring and agree on next steps.4 It also created Coastal 365, a clinic that's open year-round, including on evenings, weekends, and holidays.


In 2012, its first year, Coastal Medical saved $7.2 million. Half of that went to CMS, while some was returned as repayment for the loan. That left about $1 million for the ACO, which reinvested part of those savings and distributed the rest to all its employees—from receptionists and office managers to nurses, pharmacists, and physicians.


Not all ACOs in the Medicare Shared Savings Program fared as well. Only 52 actually earned shared savings after their first year or 18 months.5 The rest either failed to achieve enough savings to qualify for bonuses or had costs that exceeded their spending targets. In a few cases, ACOs forfeited at least a portion of their shared savings by not meeting benchmarks for quality of care or not reporting data on all 33 quality measures.
Some ACOs struggled with program changes the government made mid-course, including revisions in savings targets. ACOs that did well out of the gate tended to have made investments in the information technology systems, data analytics tools, and staff needed to identify at-risk patients and monitor their care. Montefiore Health System, based in the Bronx, New York, is a good example. In 2011 it was selected for Medicare's Pioneer ACO program, which is similar to the Shared Savings Program but designed for organizations with experience working with a set budget.


Montefiore Health System helps sponsor the Tour de Bronx, a free bicycling event designed to encourage physical activity and interest in the sport by touring bike-friendly sites in the community. Photos courtesy of Montefiore Health System


After two years, Montefiore had achieved $27.4 million in shared savings, more than any of the other 32 Pioneer ACOs. "When people ask why we've been successful," says Kate Rose, Montefiore's senior director for public policy and government relations, "I say one reason is because we think about the work that needs to happen before a person gets medical care and the work that needs to happen after."


Montefiore's investment dates to the 1970s, when the local economy took a nose dive and many primary care physicians fled the Bronx. Left to care for patients who were often poorer than the general population, the health system created its own network of primary care clinics and hired a cadre of care managers to attend to patients' often considerable nonmedical needs, such as safe housing, nutritious food, transportation, and social supports.


More research is needed to see if the investments in better care management going on across the country will improve outcomes. But there are some promising signs. One study found that patients in Shared Savings ACOs noticed improvements: they reported that they had more timely access to care, and that their primary care physicians were more informed about their specialty care. And patients with multiple chronic conditions rated their care higher overall than before.6 Still, ACO participants are making investments that may take years to achieve significant impact.




Paying for Value

The Medicare ACO programs are one way the ACA promotes greater accountability among providers for the cost and quality of care. The law also imposes penalties on hospitals when patients develop preventable infections at higher rates, or discharged patients have to be readmitted for avoidable conditions. There are signs the penalties are having an impact: the Department of Health and Human Services (HHS) reported that 50,000 fewer patients died in U.S. hospitals between 2010 and 2013 from postsurgical wound infections, dangerous drug reactions, and other "adverse events." And $12 billion was saved as a result.7
The health reform law is testing other payment reforms as well.  

Bundled Payments for Care Improvement


The Bundled Payments for Care Improvement initiative aims to reduce the wide variation in quality of patient care across the U.S. That variation means a lot of Americans aren't receiving treatments that are recommended by national guidelines. It also means costs are often much higher than they should be.

Like the ACO programs, the bundled-payment approach encourages physicians, hospitals, and nursing homes to work together to improve outcomes for Medicare beneficiaries and reduce their health care costs. Providers receive a lump sum sufficient to cover all the care required for, say, a hip or knee replacement, or for treating a heart attack. Providers that manage to keep expenses below a target and meet performance benchmarks can keep all or some of the savings, with a higher share going to those that are willing to assume the cost of going over budget. The Medicare program benefits, too, since the bundled price is lower than what it would otherwise pay if physicians, hospitals, and nursing homes billed separately for services, facility fees, and supplies.


The 6,600 providers that have joined the program choose to accept bundled payments from a list of nearly 50 conditions and procedures.8 Some participants are focused on improving the quality and efficiency of care within hospital walls, while others concentrate on what happens during and after a hospital stay, or strictly after.

How a bundled payment works


Baptist Health, a five-hospital system in San Antonio, joined the bundled-payment program when it began late in 2013. It has already had success in a Medicare demonstration designed to test the model--receiving bundled payments for 28 orthopedic and nine cardiovascular services, working closely with physicians to develop clinical protocols and standardize the use of devices and implants to achieve greater discounts from suppliers. In all, Baptist saved $9 million over three years.

"Before that, the cost of doing the same case across five hospitals could vary greatly. Even the same physicians performing the same procedures at two of our hospitals had different costs," says Michael Zucker, chief strategy officer for the health system.


As part of the Bundled Payments for Care Improvement initiative, Baptists' physicians are now working to reduce variation, improve quality, and cut costs. If they are successful, they will receive a share of the savings on a quarterly basis. A recent focus has been reducing the use of blood products during joint replacement surgery, which carries risks to the patient in addition to extra costs. Because of efforts like this, infection rates have come down, and quality metrics related to surgical care have improved.

Bundled-payment programs present some challenges for participants. For one, divvying up payments based on providers' respective contributions entails a complicated and time-consuming review of claims. And some payers find it difficult to reach consensus on the services that should be included in a bundle. But as payers and providers gain experience with bundled payments and come to realize their savings potential, this novel way to pay for care may gain traction.





Strengthening Primary Care

In addition to promoting efficiency and fostering greater collaboration across providers, the ACA also seeks to strengthen primary care. Whether practicing in a doctor's office or a community health center, primary care clinicians are often the first contact we have with the health care system. They diagnose and treat problems before they become serious, promote healthy behaviors, and coordinate care with other providers. With good primary care, patients can often avoid hospital stays and costly visits to specialists.
The health reform law aims to strengthen and transform primary care practice in a number of ways. We report here on three reforms.  


The Commonwealth Fund’s Melinda Abrams talks about how the Affordable Care Act is testing new models of care delivery and payment that emphasize quality, efficiency, and accountability.

Comprehensive Primary Care Initiative


Operating in seven regions around the country, the Comprehensive Primary Care Initiative encourages commercial insurers to join forces with Medicare and other public programs to ensure that primary care providers have the money and support they need to deliver more intensive services to their sickest patients.

In the Cincinnati-Dayton area where Ohio borders Kentucky, nine public and private insurers covering nearly 220,000 patients came together to offer monthly care management fees to 75 primary care practices, some in Kentucky. Anthem Blue Cross Blue Shield, which had already partnered with Humana and UnitedHealthcare to support physicians who needed to hire additional staff to help at-risk patients, said bringing Medicare and other payers into the mix meant that nearly all patients in participating practices would be eligible for enhanced care, should they need it. Within 18 months, the program brought down medical costs by 2 percent compared with expected trends for Anthem's patients, says Barry Malinowski, M.D., the company's medical director. "We are improving the quality of care, and with that I believe we are going to see continued reductions in costs."


The cost of care for Medicare patients in the region did not drop in the first year, but Richard Shonk, M.D., chief medical officer for the organization overseeing the region's initiative, says he expects that to change in year two because of data showing a 14 percent decline in hospital admissions for patients with chronic conditions. "I tell everyone that's the metric to watch because if team-based care is going to have any impact, it's going to be for patients with chronic diseases. If they are managed better, that is where we should see further reductions in hospitalizations," he says.

For Utica Park Clinic, a large group practice in Tulsa, Okla., participation in the initiative has led to much closer partnerships with insurers, including Blue Cross and Blue Shield of Oklahoma, which has given the practice access to its robust claims database. "We can now go patient by patient and identify those patients in a practice with a specific illness, and begin to manage those people as a group, instead of hearing about them after their third or fourth hospitalization," says Jeffrey Galles, D.O., chief medical officer. The extra funding has also allowed the clinics to surround patients with social and behavioral support services and to develop educational videos, like one on grocery shopping for people with diabetes or hypertension.

Health Homes


While Medicaid provides coverage to large numbers of low-income Americans, more than half its spending goes to the care of just 5 percent of beneficiaries.10 Some of these patients struggle with complex or multiple chronic conditions like heart disease, or with issues like substance abuse or depression. Caring for patients grappling with both physical and behavioral health conditions can be quite costly, because one poorly controlled condition can exacerbate another.11


Recognizing this, the ACA allows state Medicaid programs to designate certain providers as "health homes" that integrate physical health, mental health, and substance abuse services.12 These sites provide hands-on care management to patients, with the federal government paying the lion's share of the costs of these extra services for two years.


For the Crider Health Center, a Missouri clinic that became a health home in 2012, the financial support enabled it to hire seven nurse care managers for 1,500 patients with depression, bipolar disorder, schizophrenia, or other conditions, often compounded by chronic medical conditions. The nurses meet with patients before their psychiatric visits to perform routine health checks, like monitoring cholesterol levels, and to identify gaps in care. They also convene meetings with primary care physicians, behavioral health professionals, and community support workers to discuss those with the most complex health problems. This team approach can help clinic staff learn, for example, that a patient hasn't been taking her medication because she's more worried about paying her utility bill, or that a certain antipsychotic medication is interfering with another patient's metabolism, complicating efforts to control his diabetes.

"In the U.S. we're very used to treating behavioral health and physical health separately," says Cindy Luce, senior director of outpatient behavioral health. "Now we're saying you have to connect the head to the rest of the body."


After federal funding ran out in 2014, Missouri opted to continue to support Crider and the state's other health homes. A progress report had shown the model was working. In their first 18 months, the state's 28 health homes based in mental health clinics had reduced costs among 18,408 patients by more than $23 million, in part by helping patients avoid disease complications.
But the level of state funding for health homes enables Crider to hire only one nurse care manager for every 250 patients. "We're doing this well with that ratio," says Nancy Gongaware, Crider's senior vice president for outpatient health care. "Do you have any idea what we could do if the ratio was much less than that?"

Independence at Home

One family's experience
with Independence at Home
Sylvia Trujillo was so desperate to have her 68-year-old mother Carolyn enrolled in the Independence at Home demonstration, she moved from one part of the District of Columbia to another, in the catchment area served by the MedStar Washington Hospital Center's house calls program. In the years leading up to the move, her mother was in and out of the hospital every month or so, as Trujillo struggled to find a physician who could manage her multiple, cascading health problems. These included diabetes, depression, and early dementia, as well as a rare genetic disorder that prevented her body from processing copper, which led to a host of health problems including multiple falls. "She easily saw 20 to 30 different physicians, because no one could figure out what was going on," Trujillo says. Between taking her mother to appointments, shuttling medical records from one clinic to another, and trying to keep each physician informed about the work of the others, Trujillo was exhausted. Having the option of home visits from a team of providers who coordinated her mother's care changed both her and her mother's lives. The MedStar team began to reduce her mother's medications and monitored her closely to address problems before they became bigger ones. With this personal attention, her mother steadily improved to the point where she had only one hospitalization in the last year. "One day, I'm going to add up all the money this program saved Medicare," Trujillo says.Like the health home program, the Independence at Home demonstration targets a subset of high-need, high-cost patients who accrue large expenses—in this case, elderly Medicare beneficiaries with chronic conditions and functional limitations.13 Because these individuals are often too sick or disabled to visit their doctors, physicians have a hard time detecting and responding to changes in their health status—such as difficulty breathing or weight gain—that can snowball into medical emergencies. The demonstration, involving just 17 medical practices, is testing whether making house calls and providing additional oversight to these patients will lead to better outcomes and lower costs.
The practices rely on teams of geriatricians, nurse practitioners, and social workers, among others, to make homes visits, during which they check patients' conditions, review medications, assess the safety of their living conditions, and try to catch problems before they worsen. Those sites that save money for Medicare—above 5 percent of the predicted cost of caring for patients using more traditional methods—will receive 80 percent of the additional savings. Many sites are hopeful they'll hit the mark. Oregon-based HouseCall Providers, for instance, saw hospital readmissions for its patients drop to 7 percent last quarter, down from 17 percent in 2012.


Another participant, Washington, D.C.–based MedStar Washington Hospital Center, aims to help patients wishing to spend their last days at home do so without concern they may be deprived of services. MedStar serves an elderly, mostly African American population. National figures suggest about 70 percent of African Americans die in hospitals and only 6 percent at home, in part because of their historical underuse of hospice services. But in MedStar's house calls program, 60 percent die at home, while 25 percent die in the hospital and 15 percent in inpatient hospice programs. "They die where they want with dignity and comfort. They also happen to not be in the super high-cost institutions," says George Taler, M.D., director of long-term care for MedStar.

Taler is hopeful this demonstration will be expanded to radically reshape care for the elderly. "If this goes national, we are going to be using the home and the nursing home far more than we are going to be using the hospital, and doctor's offices will be for ambulatory patients, as they were designed to be," he says.




The Next Five Years, and Beyond
Trends in Health System Improvement
The effects of the Affordable Care Act are just beginning to be felt in physicians' offices and hospitals around the nation. Although it's not possible to link these changes directly to the ACA, several recent trends suggest that U.S. health system performance is already improving.






First, national health care spending has grown far more slowly than usual in recent years, rising only 3.6 percent in 2013, the lowest annual increase since the Centers for Medicare and Medicaid Services began tracking this statistic. This historic slowdown was a factor in the Congressional Budget Office's decision to revise down its 10-year projection of the federal costs of the ACA's coverage provisions by $142 billion. Between 2015 and 2019, these costs will be 29 percent lower than the agency originally projected in 2010.


There have also been improvements on several important measures of health care outcomes. From 2007 to 2013, there was a 33 percent drop in 30-day readmissions (per 1,000 Medicare beneficiaries). The number of hospital admissions for health conditions that should be manageable in outpatient settings dropped by 27 percent for beneficiaries ages 65 to 74. And between 2012 and 2013, there were decreases in several types of hospital-acquired infections.

Whether these improvements are attributable in whole or in part to provisions in the ACA, they are good news for patients.Five years removed from the Affordable Care Act's passage and just a few years since many of its health care delivery system reforms got off the ground, it's far from clear what kind of impact we will see. These reforms are still in their testing phase, as experts try to figure out the best way to achieve the overarching goal of better care at lower cost. The law's multifaceted approach reflects the reality that there is no single path forward, that no single innovation will work everywhere, in every environment.

Still, these stories from the field are examples of early progress. When taken together with reform efforts already under way in every state in both the public and private sectors, they suggest the ACA is beginning to move care delivery in the right direction. Will the nation be able to maintain, even accelerate, this momentum? Will the leadership, resources, and commitment be there to ensure success? Will patients agree to play a bigger role in decisions about their care and their health? In the coming months and years, we should begin to get answers to these and other key questions. Stay tuned.


______________________________________________
Each one of these foreign nations has Foreign Economic Zones building global health tourism corporations filled with global health corporations like JOHNS HOPKINS-----so what were lots and lots of small clinics around a US city or downtown emergency care facilities in low-income communities will slowly disappear at the same time OBAMA and Clinton neo-liberals made our private hospitals able to refuse citizens with no health insurance or not the right health insurance. THE US NEVER ALLOWED CITIZENS NEEDING CARE TO BE REFUSED UNTIL AFFORDABLE CARE ACT under Obama and Clinton neo-liberals.

We were shouting this would happen----we said it would look just like this 5 years ago when Clinton neo-liberals in Congress were unfolding Affordable Care Act---this is not a surprise----it is MOVING FORWARD!

Look as well from where these articles are written------here we have that same global IVY LEAGUE corporation grad---she as all media being filled with global IVY LEAGUE are not going to tell us the TRUTH and this harms not only the 99% of global labor pool but the 99% of American citizens trying to have careers and jobs.....................


'Author Photo

Jennifer Adaeze Okwerekwu is a first-year resident in psychiatry and a columnist for STAT. She received her MD from the University of Virginia in the spring of 2016. Jennifer is passionate about exploring the intersection between medicine and media. She worked as a medical student producer for "The Dr. Oz Show" and as an intern for CNN's medical unit, Radio Disney, and the Kaiser Family Foundation Health Reporting Program. Jennifer graduated from Harvard University in 2010 where she majored in visual and environmental studies (film studies) and minored in health policy. In 2011, she received a Master of Science in narrative medicine from Columbia University'.



Off the Charts


Trump’s immigration order could stop medical careers before they begin

Mike Reddy for STATBy Jennifer Adaeze Okwerekwu @JenniferAdaeze
January 29, 2017

n Friday evening, President Donald Trump signed an executive order halting immigration from Syria, Iran, Iraq, Libya, Somalia, Sudan, and Yemen. It’s a reckless order that has sweeping implications for the medical community and its future generations.


In March, medical students and graduates of foreign medical schools will learn if they matched with a residency program and can pursue their medical careers. With Trump’s executive order come concerns that applicants from those seven countries will be disregarded because of questions over whether they’ll be able to enter and stay in the United States. The order could easily end medical careers in America before they begin.
I’m a first-year resident at Cambridge Health Alliance, so I remember distinctly the difficulties and anxieties of applying for a residency. For a woman I know here in the Boston area, the executive order has added an extra layer of stress to an already stressful situation.
article continues after advertisement

She is a young doctor from Iran who has had several interviews all over the US. She is worried that her application will be disregarded if a program director thinks that she won’t be able to get back into the US if she goes home. She’s just applied for a visa renewal and worries that a hospital won’t take a chance on her, even though she is well-qualified.


A program in Ohio has already made such decisions.
“It’s very unfair,” she said. The woman asked not to be named out of fear for her placement. “We may not have a chance to get into residency because of this law.”
Read MoreAs Trump worked on his immigration ban, Hillary Clinton showed her support for immigrant cancer researchers After finishing medical school in Iran, she moved to the United States in 2014 to train in neurology. She landed eight interviews this season, which is a testament to how well her skills are regarded. Because of the order, it’s unclear which programs are still considering her and which have decided not to.

This makes my heart sink. I come from a family of immigrant doctors, and I’m intimately familiar with the extra hoops foreign medical graduates need to jump through in order to train and practice in the United States. From securing research opportunities to doing additional rotations and observerships, international medical graduates often need to do more than the average American medical student just to get a foot in the door for a residency spot.


We need doctors — there are shortages in nearly every specialty. For decades, the US has relied on foreign medical graduates to fill unmet need.

Trump’s “extreme vetting” of Muslim immigrants may turn her dream into a nightmare. She’s convinced her nationality will affect decision-making.
“It feels like you are suffocating because you cannot do anything ” she said.


 Another doctor I spoke to from Sudan has been preparing for three years to apply for a competitive spot in vascular surgery. He also asked for anonymity for fear of visa problems.
Between taking his medical licensing exams and securing rotations with different surgeons, he has been forced to travel back and forth between the US and Sudan because his visas have allowed him to be here only three months at a time. Despite these obstacles, he was also able to secure eight residency interviews.
“What I’m worried about is how this can affect the rank order lists, because this news, when it came, it came at a critical time for us,” he said. “It’s really a big blow for doctors who want to do residency in the US. We spend a lot of money and we spend a lot of physical time since our graduation to come here.”
He could have gone to the UK or Saudi Arabia, but he told me that he came to the US because there is no limit to achievement here. He plans to call program directors to plead his case.

“I’m shocked … I’m really overwhelmed about what is going on,” the man said.

For residents already in training here, the ban has implications too.
Last week, hours before Trump signed the order, I received a letter from the Committee of Interns and Residents, warning our members not to travel outside of the US.
“If you are from a Muslim majority country, we recommend seeking legal advice from an immigration attorney before exiting the U.S,” the advisory warned.
The CIR’s website even advises all foreign nationals legally working in this country to take precautions. “At this juncture, nationals of all countries may want to consider postponing all non-essential travel until the implications of this order become more apparent.”


With all that has happened since Friday afternoon, I have realized that the executive order applies to me in a way that could affect my family — and my career. I’m married to a green card holder, and that means for the time being, we can’t travel together to visit family abroad any time soon. It’s a decision we made out of fear and uncertainty. Nothing seems more un-American than that.


______________________________________________


TRUMP is installing the same global health care policies written by a global corporate tribunal ----with Johns Hopkins et al right there at the table----TRUMP is not against high-skilled foreign workers in health care---he is simply restructuring US health care. What looked to be doctors for rural and low-income communities will disappear----as US citizens are transitioned into telemedicine and out patient care facilities. Remember we have to have PRIMARY CARE DOCTORS to access what are our strong medical hospitals and facilities and those PRIMARY CARE DOCTORS must be on staff of these new ACOs ----this coming decade will force Americans to accepting they no longer have ordinary health care access. This ban is not permanent-----global health corporations and systems in US Foreign Economic Zones will be filled with global labor pool --they are simply using these shortages to move more and more people out of ordinary health care access.
WHAT IS THE SOLUTION? Well, it is EASY PEASY-----

health institutions like global IVY LEAGUE JOHNS HOPKINS have been built these few decades totally on taxpayer funding----a trillion dollars of taxpayer money over these few decades built the global Johns Hopkins campus in Baltimore ----THE PUBLIC OWNS JOHNS HOPKINS MEDICAL CAMPUS-----WE SIMPLY NEED TO MAKE IT PUBLIC. Giving Hopkins the opportunity to return that trillions to the public allows them to go overseas and have their global health tourism in Foreign Economic Zones.

IT'S INCREDIBLE THAT TRUMP WOULD DO THIS we hear----well NO IT IS MOVING FORWARD and we told folks 5 years ago this was the goal.

Trumponomics

Visa ban could make doctor shortage in rural America even worse
by Parija Kavilanz   @CNNMoney February 2, 2017: 3:48 PM ET


Arab-American business owners: We create jobs & wealth

America's health care system relies heavily on foreign doctors, especially in underserved areas already struggling with a serious doctor shortage.Now physicians groups, medical colleges and doctors in the field are concerned that President Donald Trump's temporary immigration ban restricting people from seven Muslim-majority countries from entering the U.S., will mean there will be even fewer doctors available in rural communities.


"There could very well be a patient in a rural area who had an appointment with their doctor this week and the doctor was not allowed back into the country," said Matthew Shick, director of government relations and regulatory counsel with the American Association of Medical Colleges. "At a time when the United States is facing a serious shortage of physicians, international medical students are helping to fill an essential need,"

Each year, more than 6,000 medical trainees from foreign countries participate in medical residency programs through J-1 non-immigrant visas, according to the American Association of Medical College (AAMC). J-1 visa holders who were out of the country when the ban went into effect won't be able to start or finish school unless it's lifted.


There are also about 1,000 J-1 visa applicants who are seeking to go to medical school this year who are from the seven countries affected by the ban, according to the AAMC
Once they complete their residency, physicians can either return to their home country for two years before they are eligible to re-enter the U.S. through a different immigration pathway, such as an H1-B worker visa, or they can apply for a Conrad 30 J-1 Visa Waiver.
This allows them to extend their stay in the U.S. as long as they commit to serving in rural and underserved areas for three years.

More than 6,000 medical trainees from foreign countries enter the U.S. each year on J1 visas for residency programs. Many of them go on to practice in underserved rural and urban communities in America.
In the last 15 years, the Conrad 30 J-1 Waiver has funneled 15,000 foreign physicians into underserved communities, according to the American Association of Medical Colleges.


"Even though this is a little known visa program, the J-1 Visa Waiver has done more to recruit physicians to underserved areas in this country than even the National Health Services Corps," said Shick. (The federally-funded National Health Services Corps offers loan repayment assistance to physicians who are either U.S.-born or nationalized citizens who agree to work in places where there's a shortage of doctors for at least two years.)

The American Medical Association, which represents medical doctors across the country, sent a letter Wednesday to the Department of Homeland Security asking for clarity on the visa ban.


"While we understand the importance of a reliable system for vetting people from entering the United States, it is vitally important that this process not impact patient access to timely medical treatment or restrict physicians and international medical graduates (IMGs) who have been granted visas to train, practice in the United States," the letter said.


The AMA stressed that the ban would worsen access to health care in rural areas, noting that foreign medical graduates are "more likely to practice in underserved and poor communities, and to fill training positions in primary care and other specialties that face significant workforce shortages."


The Department of Homeland Security did not directly respond to an inquiry regarding the impact that the immigration ban is having on the medical community. Instead, the agency said it will continue to enforce the executive orders which "ensures that we have a functional immigration system that safeguards our national security."
The State Department, which manages the J-Visa program, said it is aware of the AMA's request for clarification on the visa ban.


State Department spokesman Nathan Arnold said the government may issue J-visas to people who are from one of the blocked countries if it is of "national interest." He would not confirm whether a doctor shortage would be considered in the national interest. Instead, Arnold said exceptions are being considered "on a case-by-case basis" and the agency would "provide additional details as they are available."

The nation's teaching hospitals are trying to assess how the ban could hurt the pipeline of future physicians.
Mid-March is when Match Day happens. This is when graduating medical students are matched with residency programs.
"No one knows the long-term effect of the executive order," said Mona Signer, president of the National Residency Match Program.
She said medical organizations and teaching hospitals are seeking clarification from the Trump administration.
"However, it seems likely that residency program directors will be reluctant to rank J-1 visa applicants because they may not be able to enter the country to begin training."
The AMA is worried, too.
"Guidance is urgently needed from the Administration to ensure the upcoming residency matching program does not leave training slots vacant and that all qualified international medical graduate applicants can participate," the letter said.

__________________________________________

Think all those hundreds of billions paid for all the medical training for foreign students now being sent to work in global health corporations in overseas Foreign Economic Zones? YOU BETCHA------


'New York spent more than $15 billion on Medicaid last year, roughly 30% of all state expenditures. The Kaiser Foundation projects that over the next 10 years, New York taxpayers will shell out some $433 billion for the program'.


Remember, all this funding for training of foreign doctors and medical staff occurred during Obama------if they were really interested in seeing our rural and low-income communities with doctors and medical staff they would have placed US citizens as priority---meanwhile US citizens with medical degrees are among the unemployed/underemployed.


ObamaCare created a Medicaid time bomb
By Michael D. Tanner
December 7, 2013 | 9:15pm




The good news, if you want to call it that, is that roughly 1.6 million Americans have enrolled in ObamaCare so far.


The not-so-good news is that 1.46 million of them actually signed up for Medicaid. If that trend continues, it could bankrupt both federal and state governments.
Medicaid is already America’s third-largest government program, trailing only Social Security and Medicare, as a proportion of the federal budget. Almost 8 cents out of every dollar that the federal government spends goes to Medicaid. That’s more than $265 billion per year.

Indeed, already Social Security, Medicare and Medicaid account for 48% of federal spending. Within the next few years, those three programs will eat up more than half of federal expenditures.

And it’s going to get worse. Congress has shown no ability to reform Social Security or Medicare. With ObamaCare adding to Medicare spending, we are picking up speed on the road to insolvency.
The Congressional Budget Office projects that, in part because of ObamaCare, Medicaid spending will more than double over the next 10 years, topping $554 billion by 2023.


And that is just federal spending.

State governments pay another $160 billion for Medicaid today. For most states, Medicaid is the single-largest cost of government, crowding out education, transportation and everything else.


New York spent more than $15 billion on Medicaid last year, roughly 30% of all state expenditures. The Kaiser Foundation projects that over the next 10 years, New York taxpayers will shell out some $433 billion for the program.
But none of these projections foresaw that so many of ObamaCare’s enrollees would be Medicaid eligible.
To be sure, the health-care law’s designers saw the expansion of Medicaid as an important feature of their plan to expand coverage for the uninsured. Still, they expected most of those enrolling in ObamaCare to qualify for private (albeit subsidized) insurance.
It’s beginning to look like that was just another miscalculation, one that could have very serious consequences for the program’s costs.

Moreover, any projection of Medicaid’s future cost to New York taxpayers assumes that the federal government keeps its promise to pay 100% of the cost for Medicaid’s expansion over the next three years and 90% thereafter. But given the growing burden that Medicare will put on a federal budget already facing high debt levels, how likely is it that changes in the federal share of Medicaid will stay off the table?


In fact, as part if last December’s fiscal-cliff negotiations, the Obama administration briefly considered changing to a “blended” reimbursement rate, somewhere between the current and promised rates. The administration quickly backed away from the offer, but it’s likely to come back in the future. If it does, it would cost New York tens of millions of dollars.

Every bit as bad as the cost is the fact that for all this money, recipients are going to get pretty lousy health care.
Of course, one might say that even bad health care is better than no health care. But, unfortunately, for Medicaid, that’s not true.
The Oregon Health Insurance Exchange study, the first randomized controlled study of Medicaid outcomes, recently concluded that, while Medicaid increased medical spending increased from $3,300 to $4,400 per person, “Medicaid coverage generated no significant improvements in measured physical-health outcomes.”

Other studies show that, in some cases, Medicaid patients actually wait longer and receive worse care than the uninsured.
While Medicaid costs taxpayers a lot of money, it pays doctors very little. On average, Medicaid only reimburses doctors 72 cents out of each dollar of costs. ObamaCare does attempt to address this by temporarily increasing Medicaid reimbursements for primary-care doctors, but that increase expires at the end of next year.



Because of the low reimbursement, and the red tape that accompanies any government program, many doctors limit the number of Medicaid patients they serve, or even refuse to take Medicaid patients at all. An analysis published in Health Affairs found that only 69% of physicians accept Medicaid patients. A study published in the New England Journal of Medicine found that individuals posing as mothers of children with serious medical conditions were denied an appointment 66% of the time if they said that their child was on Medicaid (or the related CHIP), compared with 11% for private insurance — a ratio of 6 to 1.

Even when doctors do still treat Medicaid patients, they often have a harder time getting appointments and face longer wait times. One study found that among clinics that accepted both privately insured children and those enrolled in Medicaid, the average wait time for an appointment was 42 days for Medicaid compared to just 20 days for the privately insured. One study found that among clinics that accepted both privately insured children and those enrolled in Medicaid, the average wait time for an appointment was 42 days for Medicaid compared to just 20 days for the privately insured.


That’s one reason why so many Medicaid patients show up at the emergency room for treatment. They can’t find a doctor to treat them otherwise.
This not only increases the strain on already overburdened emergency room doctors, but increases the wait for those who arrive with real emergencies.

As bad as this is now, ObamaCare will make it worse by increasing the number of people on Medicaid without doing anything to increase the number of doctors treating them.


We don’t know yet whether the rush to Medicaid will continue. It may be that the troubles with the ObamaCare website might have skewed the early signups. But if ObamaCare really does lead to a massive expansion of this costly and inefficient program, that’s bad news for taxpayers, providers and patients.

______________________________________
When US citizens wonder where several decades of paying PAYROLL TAXES to have a strong medical health coverage as seniors went---THIS IS IT====it built global health systems overseas in Foreign Economic Zones and these few decades has seen our Federal and state university student loans and scholarships going to fund what was always meant to be doctors and staffing in these global IVY LEAGUE medical systems----and yes our global religious corporations have their own brand overseas as Americans see their strong first world health care fall to third world-----these global health campuses are serving the global 1% and their 2% in Foreign Economic Zones. Our US health systems will do the same---competing to be that destination for the world's global 1%====thanks to our PAYROLL TAXES----our FEDERAL HEALTH AND SCIENCE RESEARCH TAXES----thanks to our FEDERAL HUD funding to build global corporate campuses like JOHNS HOPKINS EAST MEDICAL CAMPUS.

It is Hopkins who champions Trans Pacific Trade Pact and Foreign Economic Zone policies here in the US and they are behind TPP killing public health in all nations forcing global citizens into private, predatory health care rather than building a model of American public health systems that WORKED FOR WE THE PEOPLE THROUGH LAST CENTURY.
These people are not working to make health care better around the world---they are working to build a system where the world's rich pay more and more and more for health procedures----THAT'S ALL FOLKS.


The Johns Hopkins University Ethiopia
Personnel Policy Manual


Section 1:
Introduction

A.
General Policy

1. This manual is the official statement of the Johns Hopkins University {hereinafter
the 11 University'' or "JHU") personnel policies for Ethiopia. It is the responsibility of each
manager and supervisor to administer these policies consistently and impartially.


2. The policies in this manual are applicable to
all local staff employed by the University
in Ethiopia, exclusive of United States citizens and those on the Baltimore payroll.


Scholarships

Johns Hopkins pre-med student earns coveted Luce Scholarship

Senior Melaku Arega, a native of Ethiopia, plans to pursue HIV/AIDS work in Asia

LEFT SOCIAL DEMOCRATS don't want to deny any global citizen opportunity-----we know to where these stances go and it is not for the betterment of those African citizens needing strong health care access or this young man being sent overseas to work in a Hopkins facility in other Foreign Economic Zones.


David Peters to lead Johns Hopkins' Global Health Signature Initiative
By Julie Messersmith
/ Published Apr 4, 2016



David Peters, chair of the Department of International Health at the Johns Hopkins Bloomberg School of Public Health and an expert in the improvement of health systems performance, has been appointed director of Johns Hopkins' Global Health Signature Initiative.
Peters will work with faculty, staff, and students from across the institution to address pressing health issues around the world.
"At Hopkins, we have the opportunity to bring together the best scientific and creative minds to collaboratively address health inequities," Peters says. "This initiative will mobilize and consolidate our expertise in order to address these complex problems facing the world's most disadvantaged people."


The Global Health Signature Initiative, part of the Rising to the Challenge capital campaign, works to bring together scholars from public health, medicine, nursing, engineering, economics, public policy, and beyond to develop lifesaving solutions in such areas as food and nutrition security, counterfeit and substandard drugs, antimicrobial resistance, and universal health coverage. The signature campaign initiatives, in tandem with the Bloomberg Distinguished Professors, are part of a coordinated effort to leverage and strengthen divisional expertise to create solutions for the most critical global issues.


Peters will begin his new role by consulting across the Johns Hopkins community to identify the institute's thematic areas of focus. He will work in partnership with government, civil organizations, and fellow academic partners to identify needs in the global community and expand the capacity to find comprehensive solutions to seemingly intractable problems.


"With David's exceptional record of leadership, research, and collaboration, we are confident this initiative will produce innovative lifesaving approaches and strategies," says Denis Wirtz, vice provost for research and administrative director of the signature initiatives. "As a field requiring truly interdisciplinary solutions, we are especially looking forward to witnessing the ways it is integrated throughout our divisions."
Peters, who received his bachelor's and medical degrees from the University of Manitoba, first arrived at Johns Hopkins in 1993 as a resident in General Preventive Medicine and received his Master of Public Health and Doctor of Public Health degrees at the Bloomberg School. He joined the World Bank and maintained his responsibilities there while returning to the School of Public Health as faculty in 2002.


In 2009, he assumed leadership of the Bloomberg School's Health Systems Program, became associate chair of International Health, and was named department chair in 2013.
Over the last two decades, Peters has worked in health systems as a researcher, policy adviser, educator, manager, and clinician in dozens of developing countries. He was one of a dozen U.S. health workers selected in October 2014 to stand with President Obama when he praised health care heroes serving on the front lives of the Ebola epidemic. Peters had led an international group of experts from the schools of Public Health, Nursing, and Medicine to re-focus the outbreak strategy on community-based, integrated responses, contributing to a quicker end to the epidemic in Liberia.

Previously, Peters pioneered the development of the Sector Wide Approaches in health, with the purpose of improving national leadership and coherence over health strategies, and improving coordination and accountability of policy implementation. In India, he led a research program with local researchers, government, and civil society to examine health systems and inequities, which became the basis for the Rural Health Mission and policies to improve access and financing for health care. And in Afghanistan, he created the first nationally implemented Balanced Scorecard to assess and manage health services, and conducted research that directly led to the end of user fees in primary care facilities.

______________________________________________

Baltimore is ground zero for these global corporations and markets and today we look at health care. It is this tie to Foreign Economic Zones that has our 99% of Baltimore citizens especially that 5% to the 1% NOT FIGHTING MOVING FORWARD---these young SCHOLARS in Baltimore recruited as that young Ethiopian man have long been pushed into this global labor pool----they may have been earning an American wage but that pathway is closing. I center on Hopkins because it is the global IVY LEAGUE corporation basically operated now by global hedge funds because these same structures exist in all US cities deemed Foreign Economic Zones---with an IVY LEAGUE university in your neck of the woods tied to it. Those US cities without an IVY LEAGUE close will see Baltimore's HOPKINS expanding to take your health care market.
HOPKINS and our IVY LEAGUE hospitals are predatory----they are profit-seeking----they have very little ties to MORALS AND ETHICS in their pursuit of the next PATENTED MEDICAL PROCEDURE OR PHARMA so they are not the best US exports in HEALTH CARE.
THIS IS TO WHERE ALL FEDERAL FUNDING TOWARDS MEDICAL RESEARCH FACILITIES---MEDICAL STAFF TRAINING----IT IS TO WHERE OUR MEDICARE, DISABILITY, MEDICAID TRUSTS HAVE BEEN FLOWING THESE FEW DECADES OF CLINTON/BUSH/OBAMA---and we are told that is OK because they are saving lives overseas---meanwhile Baltimore has a public health outcomes for citizens tied with third world Ethiopia.

NO----THESE GLOBAL HEALTH INITIATIVES ARE NOT ABOUT GROWING OUR AMERICAN STANDARDS OF HEALTH CARE OVERSEAS-----while hundreds of millions of Americans die from lack of access to ordinary health care.


Health Care’s Foreign Invitation

May 7th, 2012|Health Care Jobs|By JHI Staff
by JHI Staff on May 7, 2012



An interesting article entitled "Health Care’s Foreign Invasion" by Dr. Kate Tulenko ran at Salon recently. (It's adapted from her new book.)


A brief excerpt:
Approximately 15 percent of all health care workers and 25 percent of all physicians in the United States were born and educated elsewhere. This means that 1.5 million health care jobs are “insourced,” occupied by foreign-born, foreign-trained workers brought into the United States on special visas earmarked for health care jobs. This number is 50 percent greater than the total number of jobs in the U.S. auto-manufacturing industry.


Tulenko sees this situation as deplorable, and in exploring its causes largely focuses on the demand side of the situation. In essence, she argues that American society blocks most would-be home-grown health care workers from the industry by making training too competitive and costly; that the health care industry takes advantage of the fact that foreign health care workers accept lower wages and worse working conditions; and that, in failing to restrict their immigration, Congress and the president are falling down on the job.


But let's look at the supply side here—that is, the question of where these foreign-trained workers are coming from, and why they'd want to come here. They're coming from less-developed countries where decent jobs are hard to find, and good jobs are nearly impossible to find. Getting trained for health care jobs—typically nursing—is one way out. But those better-paying nursing jobs aren't in their own countries, they're here and in other more-affluent nations. Why? Well, yes, part of the reason is that there's a shortage of health care workers here. But perhaps a more important reason is that there is a lack of good health care infrastructure in their own countries. They don't by and large come here only because they admire our way of life, they come here because we have lots of good hospitals and other care facilities in which they can effectively use their skills, and their countries don't.

Tulenko points out some of these disparities herself:


The WHO Global Health Workforce Alliance estimates that there are a billion people alive today who will never see a health worker in their lives. In Ethiopia, one in 10 Ethiopian children will die before his or her fifth birthday—yet there are more Ethiopian physicians in the Chicago area than in all of Ethiopia, which, with 80 million people, is the second most populous country in Africa. As their most skilled nurses emigrate to work in U.S. nursing homes, middle-income countries such as Jamaica and Trinidad have nurse-vacancy rates of 60 percent or higher.


We could enact protectionist legislation to bar health care workers who come to the U.S., as the article seems to vaguely recommend. But here's another suggestion: Why don't we work with these countries to help them build the sorts of health care infrastructure that would provide good jobs, eliminating the main reasons for their looking to other countries for employment? We've seen that happen again and again in the countries in which Johns Hopkins has worked with local entities on health care capacity-building projects—including in Trinidad and Tobago, one of the countries Tulenko singles out. The emergence of quality medical facilities even spurs people to return to their home countries. When we helped build a leading-edge medical facility in Beirut, Lebanese health care workers who had moved to other countries came streaming back in to take jobs there.


And, though it may seem counterintuitive, helping other countries build better health-care-related educational institutions, whether it's schools of nursing, medicine or pharmacy, would also be a double win. Right now people in these countries who want good health care training often have to go to other countries to get it—and once they leave and are trained elsewhere, they're much less likely to end up in their home country than if they had been trained at home in the first place. We expect to see exactly that happen as a result of the campus we're helping to build in Malaysia.


And here's the kicker: When developing countries build better hospitals, they often find that the local oversupply of health care workers suddenly becomes a shortage of well-trained and experienced doctors, nurses, administrators, pharmacists and others. And guess what country they often turn to in order to import that talent? That's right, the U.S. For years, we at Johns Hopkins have been finding terrific jobs overseas for U.S. health care workers in the hospitals we work with in other countries. Wouldn't it be nice if instead of having to import health care workers, we became an exporter?


I'm all for training more health care workers in the U.S. for our own needs, as Tulenko urges. But I'd also emphasize looking at how to help those elsewhere in the world in ways that pay off for us, too.

_________________________________________


The private stocks in global IVY LEAGUE like Hopkins are outside the purview of US public trading but once these global corporations become established with the coming economic crash and GREAT DEPRESSION the only traders will be the global rich. That's OK say CLINTON/BUSH/OBAMA----if China's NATIONAL POLITBURO can be filled with billionaires so to can America's!



Donald Trump’s Pick for Health Secretary Traded Medical Stocks While in House

Rep. Tom Price has sponsored and advocated legislation that could affect the companies’ share prices

By
James V. Grimaldi and
Michelle Hackman

Dec. 22, 2016 6:57 p.m. ET President-elect Donald Trump’s pick to run the Health and Human Services Department traded more than $300,000 in shares of health-related companies over the past four years while sponsoring and advocating legislation that potentially could affect those

When we see LIBERALS backlash on AMA ----they are speaking of GLOBAL WALL STREET CLINTON NEO-LIBERALS----not left social liberals and this is of course nothing but POSING SOCIAL PROGRESSIVE as the Affordable Care Act was written to make AMA millionaires and billionaires. Price is that man who will make our US health care into global health systems operating just as Wall Street banks in regards to predatory and profit-driven -----


Johns Hopkins does nothing left or social democratic ------Baltimore doesn't know what that means------when Berger is said not to be a member of an American Medical Association-----as a graduate from NYC medical he no doubt SEES NO AMERICA------indeed the term AMERICAN MEDICAL ASSOCIATION is on the way out--------and that is what supporting TRUMP will mean


'Zackary Berger is a practicing Internal Medicine doctor in Baltimore, MD. ... Dr. Berger graduated from the New York University School of Medicine in 2006'.


Hmmmmmm..................................................................

Dr. Berger's Accepted Insurance

Please verify insurance information directly with your doctor's office as it may change frequently.

Aetna Signature Administrators PPO
BCBS Blue Card PPO
CareFirst BlueChoice Advantage
CareFirst BluePreferred PPO
CIGNA HMO
CIGNA Open Access Plus
CIGNA PPO
Coventry Southern Health PPO
First Health PPO
Geisinger Health Plan
Multiplan PPO
PHCS PPO
UHC Choice EPO
UHC Choice Plus POS
UHC Optimum Choice Preferred POS
UHC Options PPO


Just about every health insurer on the list above is already global -----no American health insurers and no Federal public health programs--

THIS ALL OCCURRED UNDER OBAMA WITH CLINTON NEO-LIBERALS PASSING POLICIES

'Bupa and BCBS companies will also develop new insurance products ... global provider network for people who require international health coverage, and other' ...



Liberal MDs are furious after top doctors group backed Trump’s pick for health secretary

STAT, CQ Roll Call via AP

By Rebecca Robbins @rebeccadrobbins
December 1, 2016

When Donald Trump this week tapped a surgeon-turned-congressman to run the Department of Health and Human Services, the nation’s largest physicians group swiftly endorsed the choice.


The blowback started almost at once.


Liberal doctors peppered the American Medical Association with furious tweets decrying the group’s endorsement of Representative Tom Price as a betrayal of patients and physicians. And by Wednesday night, 500 doctors had signed an online open letter titled “The AMA Does Not Speak For Us” started by the Clinician Action Network, a left-leaning advocacy group.

OH, REALLY??????????  LEFT LEANING OR CLINTON GLOBAL WALL STREET?



The outpouring of anger has exposed the bitter political rifts dividing doctors these days. Price is an AMA member, but he also belongs to a conservative doctors’ group that publishes a journal which has advanced discredited theories, such as the notions that abortions cause breast cancer, vaccines cause autism, and HIV does not cause AIDS. The same group shot into the spotlight during the presidential campaign by promoting conspiracy theories about Hillary Clinton’s health, including speculation that she’d had a seizure or a stroke.


There are left-leaning alternatives to the AMA, too, including one that has long advocated for gun control, pushes physicians to cut all financial ties with drug companies — and expressed dismay that any doctors group would back Price.

The AMA remains by far the biggest and most visible lobbying force representing doctors and medical students. The group spent $15 million just in the first nine months of this year to lobby Congress and the executive branch on everything from marijuana research to opioid prescribing to telemedicine, as well as traditional issues such as reimbursement and billing, according to federal filings.


But physicians are increasingly using social media to push back against the organization.
“The AMA is generally a force for the status quo in health care, a physicians’ guild in the old-school style of wheeling, dealing, and horse-trading to keep the billing flowing like a mighty stream into MDs’ coffers,” Dr. Zackary Berger, an internist at Johns Hopkins, said in an email. Berger, who is also the founder of Doctors Against Trump, has never belonged to the AMA.


The AMA has about 250,000 members, including doctors and medical students. Roughly 15 percent of practicing doctors in the US are full dues-paying members of the AMA, according to a 2011 estimate published in the journal of the Canadian Medical Association.

The organization has a lot at stake when a new administration comes to town: Working with Congress, the executive branch can shape everything from health insurance markets to hospital ratings systems to how much money doctors receive for treating patients on Medicaid and Medicare.


Back in 2009, when President Obama first nominated Kathleen Sebelius to run HHS, the AMA put out a statement within hours praising her “leadership skills.”
Within six hours of Trump officially nominating Price, the AMA urged quick confirmation in a tweet expressing strong support for the Georgia congressman, a former orthopedic surgeon. In a statement on its website, the group praised Price as “a leader” in developing “market-based solutions” to health policy and reducing “excessive regulatory burdens.”


The AMA didn’t mention that Price has been a vocal opponent of the Affordable Care Act. Or that he’s called for restructuring and sharply cutting federal aid to Medicaid, which primarily serves poor people. Or that he’s proposed controversial changes that could cut benefits to seniors under Medicare. Or that he has a 0 percent rating from Planned Parenthood and has opposed efforts to give women free access to birth control.

The endorsement infuriated some doctors.
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IF YOU DO NOT THINK OUR TRILLIONS OF TAXPAYER REVENUE AND OUR MEDICARE AND MEDICAID TRUSTS DID NOT BUILD A PRIVATELY TRADED GLOBAL STOCK CORPORATION----WAKE UP.
johns hopkins hospital/the

Private Company
Company Profile
Sector: Health Care
Industry: Health Care Facilities & Svcs
Sub-Industry: Health Care Facilities
The Johns Hopkins Hospital provides medical and surgical hospital services. The Hospital offers treatment services in various areas such as allergy and clinical immunology, anesthesiology, brain tumors, cancer, cardiac surgery, cardiology, children health, dentistry, and dermatology. The Johns Hopkins Hospital serves patients in the United States.
Corporate Information
Address:
600 North Wolfe Street
Baltimore, MD 21205
United States
Phone: 1-410-955-5000
Fax: -
Web url: www.hopkinsmedicine.org
Board Members
Chairman
Company
David Hodgson
General Atlantic LLC
Vice Chairman
Company
Edward Miller
Johns Hopkins Hospital/The
Director Emeritus:Head & Neck
Company
Charles Cummings
Johns Hopkins Hospital/The
Board Members
Company
Christopher Kersey
Camden Partners Holdings LLC
Key Executives
Edward D Miller "Ed"
Vice Chairman
Redonda Miller
President
Judy A Reitz
Exec VP/COO
Joanne E Pollak
Vice President/Gen Counsel
Ronald J Werthman
VP:Finance/CFO/Treasurer
G Daniel Shealer Jr
Dpty Gen Cnsl/Secy