Unbiased Analysis of Today's Healthcare Issues
This is one of the fundamental questions in health policy in recent years. Quality can be measured in two parts. First, does quality improved for targeted patients? Second, does quality improve for non-targeted patients. The first question is relatively clear. One would think that quality would improve for the patients targeted by a pay-for-performance (P4P)…
Data from the Private Equity Stakeholder Project (PESP) provides the answer. Data below are sorted by most to least number (N) private equity-owned hospitals. One can clearly see that Texas is leading the way in terms of raw numbers but New Mexico has the highest share of hospitals that are PE-owned. You can find more…
Recently, I published a paper noting that the risk of using prior authorization and step edits may vary by the disease to which this type of utilization management is applied. States are starting to pass legislation to limit how health insurers can use prior authorization rules. According to the American Medical Association (AMA), 10 states…
That is the topic of a Health Affairs Forefront article by Neprash, Perkins and Mehrotra (2025). This is an important question as approximately one in four visits are now provided by nurse practitioners (NPs) and physician assistants (PAs) across the Medicare program. NPs and PAs can either bill payers one of two ways: They can…
That is the topic from my article out today at The Evidence Base. An excerpt is below: On May 12, 2025, President Trump issued an executive order calling for “most favored nation” (MFN) drug pricing in the US. Key questions you may have include: ▪ What is MFN pricing? ▪ Which countries will be included in…
That is the topic of a JMCP Viewpoint by Sean Sullivan, Jens Grueger, Aidan Sullivan, and Scott Ramsey. Some excerpts: The Budget Lab at Yale University projected that a 25% ad valorem tariff would increase medication costs by an “average of around $600 per year per household in the United States.”3 Tariffs can also create supply…
That is the title of a new paper published in the American Journal of Managed Care (AJMC) with co-authors Jacob Fajnor, Shurui Zhang, and Donald Nichols. The abstract is below. Objectives: To (1) develop a metric that quantitatively measures the risk that utilization management (UM) policies pose to patients and (2) measure the relationship between…
These are the findings from the American Medical Association’s 2024 Physician Practice Benchmark Survey. Physicians included in the survey include those who practice in the U.S., actively see patients, and have completed residency. Here is what the survey finds: Increasingly, physicians are less likely to work in small practices that they or other physicians own.…