Scott Reiter

“Vaccine requirements in places like schools or hospitals are important for preventing the spread of disease and protecting vulnerable people and kids,” - from my interview with Colorado Public Radio School vaccine requirements play a crucial role in boosting vaccination rates, creating healthier schools, protecting children, and strengthening community health. Most parents agree: a nationwide survey this year found that 77% support vaccine requirements for school attendance, while only 8% believe they are unimportant (source in comments). Let’s join the majority of parents in standing up for healthier schools and communities. We must work together to ensure all children have the protection they need to thrive by advocating for policies prioritizing community health. #vaccine #vaccines #socialnorming

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While $50,000 a year is a pretty hefty price to pay, this is the high end of the range for concierge-level access. Other patients pay a more reasonable $2000-$5,000 yearly fee for improved access, more time with the doctor, and a consumer-focused experience. Is “freemium” health care a bug or a feature of the system? If reimbursement continues to drop and overhead continues to rise, doctors will either have to do more with less or offer premium add-on services to survive. I suspect patients will increasingly find value in reasonably priced concierge medicine or subscription-based care, not just in primary care but in specialty care too. In some ways, it’s sad that it’s come to this. But seen from another viewpoint, concierge care is a path to restoring the doctor-patient relationship, fostering innovation, and creating its own version of a competitive marketplace. Charging extra for an elevated experience creates expectations that naturally lead to better patient care. If enough practices do it, a free market naturally arises. Concerns over inequities are valid — but there are ways to creatively incentivize low-cost options that maintain access. (I mean, we do it for “not-for-profit” hospitals after all). Originally posted in this week's edition of the The Surgeon's Record (link in the comments). #medicine #healthcare #health #conciergecare #healthpolicy

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192 RA pts on MTX: GI Sxs studied w/ MISS (MTX intolerance severity score). GI intolerance seen in 56%, Nausea & pain post-MTX most common. More in afro-descendants, w/ FM, Steroids, or JAKi. MISS results unrelated to Route, Gi Dz, age, MTX dose https://buff.ly/3Sdzp3k

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Our political discourse throughout the election was notable for the relative absence of discussion of US healthcare policy. With the election behind us and a new presidential administration on its way in January, there is opportunity to shape US healthcare policy for the better of all Americans. In my latest Forbes column, I describe “10 Ways the Incoming Trump Administraiton Can Improve US Healthcare:” 1) Lower the Medicare Age to 55 2) Anti-Trust Enforcement 3) Multiyear Plan Enrollment 4) Medicare Advantage As Community Health Workers 5) Mandate Standardized Benefit Design 6) Make Star Ratings Matter 7) Fix Risk Adjustment 8) National Licensure 9) Solve Utilization Management Through Global Capitation 10) A Maternal Health Moonshot What do you see as the biggest opportunities for the incoming Trump Administration to improve healthcare? https://lnkd.in/gW7ChH6Q

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Disparities in Post-Hospitalization Care: The Road to Recovery is Uneven A study recently published in *Annals of Internal Medicine* highlights a crucial issue: disparities in post-hospitalization care are leaving some patients behind. While we often focus on the quality of care inside the hospital, the care after discharge is equally critical for recovery—and this is where many patients from marginalized communities face significant barriers. The study reveals that patients in underserved populations are more likely to experience poor transitions from hospital to home, resulting in higher rates of readmission and adverse outcomes. Factors such as limited access to follow-up care, cost of medications, social and family support, and understanding of discharge instructions are contributing to these disparities. Equitable healthcare doesn’t end when a patient leaves the hospital. We must prioritize improving post-discharge care and ensure patients are supported in their recovery journey. Let's start by addressing these gaps with targeted interventions that provide continuous care for all patients, no matter their background. #HealthEquity #PostDischargeCare #HealthcareDisparities #PatientCare https://lnkd.in/e-55k-3n

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Thoughts from the Wild Health Summits Burning GP Summit: Should there be a salaried GP model to provide for patients that aren't fit for fee-for-service? Repeatedly throughout the day, there are examples of the current funding models failing complex patients that don't fit into the fee-for-service paradigm. This has been a problem for years, and despite advocacy from lots of different groups, patients with complex health needs continue to be failed by the fee-for-service model. We are in a situation where GPs are subsidizing these patients' care with their own income, and their own families suffer a drop in financial wealth as a direct result of GP altruism. Are we now at the point where we should consider a truly publicly funded, universally accessible, primary care GP-led system? The single employer model could be a soft landing for this idea. In reality small GP clinics are continuing to fail in low socioeconomic areas due to the inability of patients to pay a gap alongside poor Medicare rebates, I'd argue the government should be stepping in to nationalize these clinics when requested by practice owners and GPs. I know there are a lot of younger GPs who would be quite happy to spend part of the week in a salaried role doing altruistic work and spending another part of the week in a different role l/clinic doing private fee-for-service work. Is it time for a discussion about what this looks like? We’ve already seen councils and other funding bodies stepping to rescue small rural clinics. Maybe it’s time for a national approach. Jeremy Knibbs Michelle O'Brien The Royal Australian College of General Practitioners (RACGP) Australian Medical Association

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On October 8th, U.S. News & World Report released its annual rankings of Children's Hospitals, called "Best Children's Hospitals". It is a 174-page report describing the methodology and data tables which I scanned through. Appendix C-10 has the data on Pediatric Pulmonology which I took a deep dive into. In the attached carousel, I have recreated two datasets that matter. If I were to shop around for a hospital for my care, what really matters to me is the outcome data for a particular condition I am seeking care for and not the reputation score. However what separates the top-ranked "Best Children's Hospitals" is their reputation scores, not the outcome scores for selected conditions as in asthma here. It's a different matter whether the outcome scores used in the rankings are good measures. We will discuss them in another post. What are your thoughts? Feel free to like, share, and comment. #healthcare #hospitals #physician

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DAX Copilot automatically documents the patient/physician conversation, reducing physician burnout and increasing productivity. Learn more at https://lnkd.in/e86xfcb7

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I wonder what has created this response from #nurses? I know. It is about patients. For nurses-- it is always about the #patient. When nurses from the nation's largest healthcare system, one that is pioneering the application of #AI in healthcare, are concerned about patient safety--- we should take notice. Nurses are the frontlines of patient care and if they are raising concerns about AI and patient safety-- it is real. They are raising concerns about patient-chatbot interactions that could (or are) direct a patient to a pharmacist instead of an MD or ED is it misinterprets the communicated symptoms of a heart attack as cold symptoms. Nurses claim that AI is making their jobs harder, not easier or more effective. They provide examples in a hospital that uses AI to track a patient's bio signs that alert nurses when there is a suspected problem with the patient--- there are many false alarms that nurses are now responding to. This is quite common in healthcare technology adoption. Technology development often does not include the end user (in this case nurses). Technology is implemented and has unintended consequences (false alarms). Technology adaptation is delayed or does not occur (nurses are stuck with the increased false alarms for years). I believe effective, safe, ethical and unbiased application of #AI in #healthcare is becoming a possibility. But patient care, patient outcomes, and staff task and experience improvements need to be foundational as this technology is applied in healthcare. When I look and walk around hospitals and clinics, I often see nurses performing non-nursing tasks. Nurses are healthCARE. 👨‍⚕️ 👩‍⚕️ They can't be replaced by AI. But if used wisely, AI can augment a nurses role and abilities in a manner to allow them to have more time with patients. That should be the goal. Some approaches that could be tested and adopted to improve a nurses' role: Voice-to-Text Documentation, Automated Data Entry, Intelligent Summarization Tools, Predictive Text and Smart Templates, Integrated Clinical Decision Support, Mobile Health Applications.. I think KP needs to listen to their nurses concerns-- learn-- adapt--test/study ---improve. Use non-financial centered and driven metrics. #UsingWhatWeHaveBetter https://lnkd.in/gwQ2nBDC

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Conversations are finally recognizing the importance of including nurse voices in tech and AI discussions. We must unite as a profession to adopt responsible AI, not just what's sold for cost management. Nurses have a powerful voice, but we need to be more unified to improve our profession and healthcare. Business, technology, and healthcare can work well together if we collaborate. Thank you, American Nurses Association - California for the conversation. Advocacy and unity are essential. We all want better healthcare, but we must work together and engage in these crucial discussions. #nursevoices #nursesunite #collaboration #techeducation #futureofnursing #changeweallcanadopt #AI #technology #progress #healthcareimprovement

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Two simple steps to reform and improve U. S. Healthcare The nation’s healthcare reform debate rages on as the primary item on the local and national agenda. And while most conversations on healthcare generate plenty of “heat”—sadly, the discussion has yielded far less “light.”   Every single one of us is affected by healthcare. So, too, our national economy suffers in terms of efficiency and effectiveness with a healthcare system responsible for over 17.3% of our Gross National Product and growing uncontrollably.   History repeats itself and today’s healthcare debates are no exception. This country has been debating healthcare reform for a century. The movement for national health insurance and expanded coverage began in the early days of the 20th century. Theodore Roosevelt seized on the issue when campaigning on the Bull Moose Party ticket in 1912. The issue was promoted by progressives in 1914 and 1917 and the 1920s, according to a 2012 New England Journal of Medicine article.    The Great Depression renewed interest in the concept with President Franklin Delano Roosevelt supporting national health insurance. But, because of intense opposition from the American Medical Association (a recurring theme throughout the last century), Roosevelt feared the whole Social Security bill might be defeated. So, he postponed the issue. Roosevelt died in 1945 before he could resurrect the plan. President Harry S. Truman formally proposed national health insurance, but the proposal died because of a mix of influences, including party politics, cries of socialized medicine, and even segregation. For one thing, the effects of globalization have accelerated our need to change. As U.S. health costs rise out of proportion to our international peers, American companies become less competitive economically. For example, health care costs American automakers about $1,500 per vehicle produced, while international manufacturers spend only about half that amount. Manufacturing is down because healthcare costs are up according to an Industry Week article.   Then there are the steadily mounting costs in the form of U.S. government liabilities from contractual commitments to retired employees for healthcare. Such costs could make health care a terminal illness for America’s governments and businesses, according to Clayton Christensen’s The Innovator’s Prescription. So we’ve got to reform our healthcare system. That’s clear. The question is, “How?”   Most of the discussions so far have been partisan and polarizing, focused on payment mechanisms and protecting one’s own “turf.” Most insurance companies, big pharmaceutical companies, device manufacturers (e.g. pacemaker and artificial joint manufacturers, etc.), hospitals, and physicians prefer the status quo. They are mostly “change-phobic.”   Prevention and evidenced-based medicine can change the direction without interfering with the physician patient relationship.  

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Calling all healthcare advocates and providers! Action is needed! To Preserve Access to Care, Congress Must Repair Medicare’s Broken Payment System  American College of Rheumatology advocates took Medicare Physician Reimbursement reform to the Hill in May. Join in these efforts by advocating from home by using our tool to contact your legislators!   Under the current system of Medicare funding, there are across-the-board cuts each year to reimbursements to physicians treating Medicare patients in the Medicare Physician Fee Schedule (MPFS). As physician-owned practices combat insecurity around varying payments from Medicare for treating patients, these patients’ access to care is put at risk. We are asking Congress to avoid putting patient care in jeopardy by passing two pieces of legislation.   The Strengthening Medicare for Patients and Providers Act, (HR 2474) to tie physician payments for treating Medicare patients to inflation by adding a permanent, Medicare Economic Index (MEI) based inflationary update to the MPFS.  The Provider Reimbursement Stability Act (H.R 6371) and Physician Fee Stabilization Act (S. 4935) to reduce the impact of budget neutrality requirements on the MPFS by raising the budget neutrality threshold from $20 million to $53 million, then increasing the threshold every five years to reflect the cumulative increase in the MEI.  The ACR’s Legislative Action Center will allow you to contact your Members of Congress. Take a moment to send your letter today! Click below to send a letter to your representatives! https://lnkd.in/epcyUqwe #medicare #advocacy #physicianfeeschedule #HR2474 #HR6371 #S4935 #rheumatology #healthcareaccess #patientaccess

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The recent updates to Appendix PP of the State Operations Manual in CMS's 902-page QSO memo signal key shifts in regulatory focus for Skilled Nursing Facilities (SNFs). Here’s a breakdown of the critical changes and their implications: Key Areas of Emphasis: 1. Antipsychotics and Schizophrenia Diagnoses: - CMS continues to target improper use of antipsychotics and inaccurate schizophrenia diagnoses. - Increased scrutiny of off-label medication use, especially those with sedating effects. 2. Resident Discharges: - Enhanced focus on ensuring discharge processes align with regulatory requirements and prioritize resident rights. 3. Medical Director Responsibilities: - Expanded expectations for medical directors to actively oversee care quality and regulatory compliance. 4. Quality Assurance and Performance Improvement (QAPI): - Greater emphasis on QAPI programs as tools for driving systemic quality improvements. - Facilities must demonstrate active and effective use of QAPI principles. 5. Pain Management: - Surveyors will examine policies and practices to ensure adequate pain management that aligns with residents’ needs and preferences. 6. COVID-19 Vaccination Education and Offerings: - Clear mandates on facilities to educate residents and staff on COVID-19 vaccination and to offer vaccines proactively. 7. Enhanced Barrier Precautions: - Reinforcement of previously issued guidance for infection prevention, now embedded into the manual. Changes to Critical Element Pathways: - Adjustments to survey probes to incorporate new guidance, ensuring surveyor focus aligns with updated regulatory requirements. Implementation Timeline: - Effective Date: February 24, 2025. - Immediate Implications: Although formal implementation is months away, surveyors are likely to prioritize these areas during inspections immediately, reflecting their longstanding focus. Training and Preparation: - CMS plans to provide public training for surveyors on these updates. Providers should stay informed and use the training materials to align their operations with the revised expectations. Action Steps for SNFs: Review and Update Policies: Evaluate policies on medication management, discharge planning, QAPI, and infection prevention. Education and Training: Train staff on pain management, COVID-19 vaccine protocols, and enhanced barrier precautions. Medical Director Engagement: Ensure active involvement of medical directors in quality oversight. Audit Practices: Conduct internal audits to identify and address potential non-compliance in the highlighted areas. This updated guidance underscores CMS's ongoing commitment to resident safety and quality care, signaling a proactive stance that SNFs must adopt to remain compliant and survey-ready. https://lnkd.in/gcqzMyHk

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𝐀𝐧 𝐚𝐫𝐭𝐢𝐜𝐥𝐞 𝐢𝐧 𝐭𝐨𝐝𝐚𝐲’𝐬 𝐖𝐒𝐉 𝐡𝐢𝐠𝐡𝐥𝐢𝐠𝐡𝐭𝐬 𝐭𝐡𝐞 𝐛𝐢𝐠𝐠𝐞𝐬𝐭 𝐝𝐚𝐧𝐠𝐞𝐫𝐬 𝐨𝐟 𝐣𝐨𝐢𝐧𝐢𝐧𝐠 𝐚 𝐌𝐞𝐝𝐢𝐜𝐚𝐫𝐞 𝐀𝐝𝐯𝐚𝐧𝐭𝐚𝐠𝐞 𝐩𝐥𝐚𝐧 – 𝐭𝐡𝐞 𝐜𝐡𝐚𝐥𝐥𝐞𝐧𝐠𝐞𝐬 𝐨𝐟 𝐥𝐞𝐚𝐯𝐢𝐧𝐠, 𝐞𝐬𝐩𝐞𝐜𝐢𝐚𝐥𝐥𝐲 𝐚𝐬 𝐲𝐨𝐮 𝐠𝐞𝐭 𝐨𝐥𝐝𝐞𝐫 𝐚𝐧𝐝 𝐬𝐢𝐜𝐤𝐞𝐫. And when older, sicker patients do leave, taxpayers wind up footing the bill. https://lnkd.in/gXY5gdRB 𝐅𝐈𝐍𝐃𝐈𝐍𝐆𝐒 “A Wall Street Journal analysis of Medicare data found a pattern of Medicare Advantage’s sickest patients dropping their privately run coverage just as their health needs soared…. “As recipients get sicker, though, they may have more difficulty accessing services than people with traditional Medicare. That’s because the insurers actively manage the care, including requiring patients to get approval for certain services and limiting which hospitals and doctors patients can use. “People in the final year of their lives left Medicare Advantage for traditional Medicare at double the rate of other enrollees from 2016 to 2022, the Journal’s analysis found…They cost the federal government an average of $218 a day during that period. That is more than seven times the cost of a typical Medicare recipient, and about twice the cost of other recipients in the last year of their lives.” Kudos to Anna Wilde Matthews, Christopher Weaver, and Tom McGinty for fine reporting. 𝐌𝐘 𝐏𝐄𝐑𝐒𝐎𝐍𝐀𝐋 𝐓𝐀𝐊𝐄 I would NEVER consider joining a MA plan. The deal killer: the requirement for individual (vs. community) rating of patients' health/sickness levels if they choose to leave a Medicare Advantage plan. I can’t fathom why this isn’t more widely understood and discussed. If you choose to get into traditional Medicare before your 66th birthday, you are eligible to buy a Medigap supplement policy at a community rating, i.e., you pay a price based on the health status of all Medicare patients in your age group. If you want to LEAVE a Medicare Advantage plan after your 66th birthday, the pricing of your Medigap plan will be determined by your INDIVIDUAL health status; you can be denied coverage. This has the effect of LOCKING people into their Medicare Advantage plan when they are older, sicker and want to leave to go to traditional Medicare...and this is where prior authorization requirements can really screw older, sicker patients. This is more a criticism of how MA is structured, and less a criticism of MA plans themselves. I'm not clear on the legislative history of why this loophole exists, but as the WSJ article notes some states have regulated against this. Can anyone enlighten? …and then you get into the arbitrary prior authorization requirements. But that’s another post. “You can check out any time you like, but you can never leave" – The Eagles, Hotel California #MedicareAdvantage #Medicare The Fast Future Executive

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Today I'm both grateful and wondering how NPR, KFF Health News and the Newsom Administration missed an opportunity to promote the state TA Marketplace giving CBO's FREE expertise to sustain and scale their services. Just Whole Care is helping CBO's just like the ones named, provide and sustain intensive care coordination (aka ECM) and asthma remediation - as well as other services addressing physical, behavioral, and essential needs through integrated, equitable, trauma-informed care, impact measurement, and systems change. It's ALL thanks to the TA Marketplace (TAM) neglected by this piece. We're talking small, Black-owned CBO's leveling up with measurement-based, equitable care and new payment methods near overnight; at least by Medicaid standards. The TAM will be critical in light of difficult budget cuts the Administration proposed last week to maternal child health, behavioral health, and public health. (Thoughts to come as details arrive.) So let's make sure we and the media ALL give credit where it's due. The California Department of Health Care Services under Secretary Ghaly, Directors Baass and Sadwith, and leaders like Palav Babaria and at PCG’s Health team are CRUSHING it - resourcing and marshalling #healthequity expertise for diverse, marginalized California communities. And doing so, using a free-market approach, California style! 🤓💪🏼🚀 For more on the TAM: https://lnkd.in/ezHTk8F3 For more on how JWC helps TAM-funded CBO's: https://lnkd.in/eK-T2_7A #gratitudeistheattitude #mentalhealthishealth #SDOH are health. Thanks Lonnie Hirsch for highlighting this for me! https://lnkd.in/egiUiXKJ

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A new study in JAMA shows the ETC payment model has shown little impact in further promoting the uptake of home dialysis and kidney transplant among patients with kidney failure in its first 2 years. 𝐁𝐚𝐜𝐤𝐠𝐫𝐨𝐮𝐧𝐝 The ETC model launched on January 1, 2021. It randomly assigned ~30% of US dialysis facilities and managing clinicians to financial incentives to increase the use of home dialysis and kidney transplant. Participants received payment incentives and penalties on the basis of their attributed patients’ use of home dialysis and kidney transplant or wait-listing. The model will run from 2021 though 2027. Achievement and improvement relative to these benchmarks are scored and translated into payment adjustments, ranging from −5% to 4% in the first 2 years of the model. 𝐏𝐫𝐢𝐨𝐫 𝐑𝐞𝐬𝐮𝐥𝐭𝐬 Evaluations of the model’s first year have reported mixed findings. • One study found a small increase in initiation of home dialysis among incident patients in ETC relative to control regions. [2] • Another study, examining incident Medicare beneficiaries 66 years and older, found no meaningful difference in home dialysis use stemming from the ETC model. [3] • This team's previous research evaluating ETC’s impact on participating safety-net facilities (those serving a high proportion of patients with social risk factors) found that the model disproportionately penalized high-risk facilities. [4] This study includes both first and second years as well as the entire traditional Medicare ESRD population (incident and prevalent). It also evaluates policy impact by race, ethnicity, and socioeconomic status. 𝐃𝐢𝐬𝐜𝐮𝐬𝐬𝐢𝐨𝐧 The authors suggest the ETC model’s limited influence on home dialysis and kidney transplant use in the first 2 years may be attributed to several factors. 1. Home dialysis use in the US has been steadily increasing since 2009, likely triggered by that year’s expansion of the Prospective Payment System (PPS). Ipso facto, there is an existing financial incentive for all national facilities. 2. The application of pay-for-performance incentives to dialysis facilities does not address patient-level barriers like stable housing or financial resources (e.g. home mods, utility bills). 3. The process of kidney transplant is lengthy, complex, and requires several steps from referral to evaluation, wait-listing, and ultimately transplant. It may take several years to see any impact. 4. Two companies operate ~70% of facilities in both ETC and control regions. The payment penalties in one set of facilities may be offset by revenue or bonuses from other facilities owned by the same company. Further, standardized care practices may reduce likelihood of interventions in ETC-only clinics. -- Sources: [1] https://lnkd.in/eQeP7_7i [2] https://lnkd.in/e-mQ9fzN [3] https://lnkd.in/eeRRC5Fh [4] https://lnkd.in/epmDcPvv

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As California goes all in on CHW’s, it will be important for them to have a role connecting everyone to social support and activities. Maybe this hasn’t been part of the conversation as much because Medi-Cal rolled out a strangely separate “Peer Support Specialist” benefit at the same time, strictly kept to county BH plans. 🤷🏻‍♂️ (It really shouldn’t be only for those with SMI FYI, there’s plenty of data peers reduce mental illness burden across all risk strata.) Or maybe we still need to do a better job of reframing social support systems and relational health as part of standard of care “health education” whether CHW’s or other health professionals deliver it. We haven’t seen that framing much to be honest and I’m not sure why. Either way, the UK and many US physicians and other PCP’s who now prescribe social activities are showing this is the way in an increasingly isolating digital age. California is also leading this charge, however not under Medi-Cal for all, so much as under child welfare reform. New plans to allow child welfare dollars to go to these kids’ social activities highlight the importance. In reality, the same should be true for Medicaid dollars for pregnant women (ala the Birthing Care Pathway?), kids and youth thankfully NOT involved in child welfare systems (but with high ACE scores?), and seniors (ala MSSP?). Essentially everyone needs safe, stable, nurturing relationships to be healthy. The moment we make relational health a cornerstone of all healthcare investments, including but not limited to paying for social activities, the more we will beat the toxicity of stress and drive down costly physical and mental health conditions. Hopefully this can be a consideration in the next round of CalAIM Community Supports - let’s pay for straight up social supports and activities through a Medicaid waiver and measure the impact. Now that would be amazing! #mentalhealthishealth. #relationalhealth investments and patient education are keys to #healthequity

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Learn how to write a patient care report that meets industry standards. Craft an effective PCR narrative with this helpful checklist and examples. ⬇

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