This is part of our Coronavirus Update series in which Harvard specialists in epidemiology, infectious disease, economics, politics, and other disciplines offer insights into what the latest developments in the COVID-19 outbreak may bring.Primary care practices are projected to lose more than $65,000 in revenue per full-time physician in 2020, following drastic declines in office visits and fees for services from March to May during the COVID-19 pandemic, according to a study led by researchers in the Blavatnik Institute at Harvard Medical School (HMS).The lost revenue adds up to a shortfall of $15 billion to primary care practices across the United States, according to the analysis to be published June 25 in Health Affairs. (DOI: 10.1377/hlthaff.2020.00794). The researchers also caution that losses would balloon substantially if there is a second viral peak later in the year or if the reimbursement rates for telehealth visits revert to pre-COVID levels.The study was led by Sanjay Basu, a faculty affiliate in the HMS Center for Primary Care, Russell Phillips, director of the center and professor of global health and social medicine at HMS, and Bruce Landon, HMS professor of health care policy.“For many primary care practices, particularly those serving the most vulnerable populations, these losses could be catastrophic, with many practices being forced to close,” Basu said. “This could weaken the U.S. health system dramatically at a time when we need it to be at its strongest.”“Our prior work shows that primary care saves lives, and loss of primary care practices will translate to lives lost across the United States,” Phillips said.To calculate the projected financial losses on operating expenses and revenues, the researchers simulated the impact of the pandemic on a variety of practices analyzing both visit volume and visit type, among other variables. They then compared the anticipated revenues, expenses and losses under several scenarios, including a second shelter-in-place order in November and December as well as reverting back to the significantly lower pre-pandemic levels of provider reimbursement for telemedicine visits.Once the most acute threat of COVID-19 subsides and the pandemic winds down, primary care in the United States will have to absorb the brunt of long-term COVID-19 care and management, testing and vaccination, the team said. The primary care system must also be equipped to meet the piled-up needs of the population and return its attention to the major chronic medical conditions that collectively will determine the health of Americans for many years to come, they said.“The coronavirus pandemic highlights the fragility of the primary care system,” said Landon, noting that “over half of primary care practices remain small and physician-owned and these independent practices have limited access to capital and other support that could help them weather the pandemic.”The researchers said their findings and the looming growth in primary care use underscores the need for a financial boost to the primary care system.“The coronavirus pandemic is a pointed reminder of the importance of primary care to our society. Primary care is critical to limiting the spread of the virus, in treating the comorbidities that can make COVID-19 so deadly and in helping people navigate the social and psychological challenges of social distancing and of living with the pandemic,” Phillips said.While legislation proposing financial aid to hospitals has already been introduced in Congress, independent primary care practices have yet to receive significant financial help, the researchers said.Additional collaborators on the study include colleagues from the American Board of Family Medicine.The authors report no external funding for this study.
By Carlos Maggi/Diálogo October 11, 2017 Within the framework of existing agreements, the Joint Staff of the Uruguayan Air Force (FAU, per its Spanish acronym), and its counterparts from Argentina and Chile are holding a bilateral meeting. Different topics of common interest are being analyzed to strengthen bonds of friendship that have historically characterized these South American nations. Uruguay has bilateral agreements with several countries in the region, including Brazil, Colombia, and Paraguay, in addition to the ones already mentioned. The challenge for air forces in the region is to acquire new technologies for their defense and to fulfill the tasks delegated to them by their respective country’s constitution and executive authority. Chronologically, the first meeting was held between the joint staffs of Uruguay and Argentina, followed by a meeting between those of Uruguay and Chile. The agenda for these meetings is established ahead of time, and topics addressed include the exchange of experiences between the two nations and support for different activities, among other things. “One of those [activities] is helping fight forest fires, and also planning a future exercise called ‘Cooperación,’ which is about coordinating all of our resources to help countries with issues like tsunamis, earthquakes, and fires, among other things,” Brigadier General (Aviator) Ismael Alonzo, the chief of FAU General Staff, told Diálogo. The bonds of friendship and cooperation between Uruguay and Argentina, and particularly between Uruguay and Chile date back to the last century. In 1915, the forerunners to Uruguay’s military aviation wing trained at the Chilean aviation school. The opportunity to exchange ideas is vitally important since it leads to acquiring more experience. “During these meetings, topics related to knowledge and specialization courses for pilots and airmen in Chile and Uruguay are also addressed. With Argentina, we analyze the same topics and issues, since both of our air forces have the challenge of committing to new technologies for our defense and to fulfill the tasks delegated to us by the constitution and our executive authority,” Brig. Gen. Alonzo added. These bilateral meetings take place every other year with each country taking turns to host. They facilitate reciprocity and allow both forces to strengthen bonds of fellowship, professional traditions, and technical capacities. The meeting between the air forces of Uruguay and Paraguay was held on August 30th in Montevideo, Uruguay. The Colombian Air Force held its meeting with its Uruguayan counterpart September 12th-16th in Bogota, Colombia, and the cooperation agreement previously signed with Brazil was reactivated. Examples of the agreements endorsed during the meetings include combined exercises such as the one called “Cooperación V,” which had been scheduled for September 25th in the Chilean cities of Santiago and Puerto Montt, as well as the Greater Island of Chiloé. The exercise was suspended to respond to emergencies in the Caribbean and Mexico caused by the recent natural disasters. The exercise would have simulated an earthquake followed by a tsunami and volcanic eruption. The 20 countries of the region comprising the System of Cooperation Among the American Air Forces would have sent personnel and aircraft to participate, with the purpose of supporting the affected area through humanitarian aid and search-and-rescue air operations. The 1,200 troops, which had planned to establish an air bridge with the support of almost 30 heavy-lift and light-transport aircraft and helicopters, were mobilized for disaster response and humanitarian aid efforts in the Caribbean after Hurricanes Jose, Irma, and Maria. Another example is the “Tanque” exercise, to be held in November between the air forces of Argentina and Uruguay. Uruguayan combat aircraft with mixed crews will be refueled in-flight by a C-130 Hercules. Bilateral accord outside of the region Uruguay has various agreements in place with other governments in the area of defense cooperation. This was evidenced by the arrival of three A-37B attack aircraft in the air base at Durazno, Uruguay, in 2014. The planes were donated by Ecuador, which had decommissioned them. “These agreements are always an opportunity. When we arrived at the Ministry of Defense, there were agreements that were practically unidirectional,” said Uruguayan Minister of National Defense Jorge Menéndez. “Today, we have broadened the range of possibilities for South American countries, also in Europe, and, to that effect, we have agreements with France, Spain, and Portugal and have just now signed an agreement with Italy. We have a few lines of negotiation which are not spontaneous, which generate work, which have to do with the acquisition and exchange of materials, and also reciprocal training, which is very important for our country,” Menéndez highlighted, adding that he is optimistic that, over the medium term, new possibilities of this type will emerge for acquiring materials for the armed forces.
NBA DRAFT TRACKER: Live results and pick analysisThe Nevada Gaming Control Board first allowed wagering on the NBA Draft in 2017. Below are a handful of prop bets collected from Caesar’s Sportsbook and Bovada .Will the Pelicans draft Zion Williamson and RJ Barrett?Yes +700No -2500Will New York Knicks fans boo the team’s first selection? Yes +145No -190 How many freshmen will be taken in the first round? OVER 12.5 -120UNDER 12.5 -120How many trades will happen on draft day? OVER 12.5 -110UNDER 12.5 -110Sum of the draft positions of Kentucky players drafted in the first round OVER 46.5 -155UNDER 46.5 +125Will Purdue’s Carsen Edwards be drafted in the first round? Yes +110No -140 Cam Reddish’s draft position Picks 1-7 +124Picks 8-30 -158 How many international players will be taken in the first round? OVER 2.5 -155UNDER 2.5 +115 While Zion Williamson is a lock to go first off the board — sportsbooks aren’t even offering odds — there are plenty of lines for fans to bet on ranging from the simple “Will Player X be drafted by Team Y” to the more complex prop bets of something like the over/under on the sum of draft positions for players from certain schools. The 2019 NBA Draft is here, and with it the hopes of every fan that their franchise will land the next big superstar. Rumors have swirled (and deals have been agreed upon) for the last seven days since the conclusion of the NBA Finals, and it’s pretty much anyone’s best guess as to which former college standout will be taken when.