Unbiased Analysis of Today's Healthcare Issues
A recent paper by Kacerek and Mattingly (2025) aims to answer why certain drugs are defined as “specialty” drugs and others are not. They first cite an Office of the Inspector General (OIG) report: The OIG found that there was no standard definition in Medicaid and that Medicaid programs used more than 100 different characteristics to…
At the end of last year, CMS finalized a rate cut for Medicare reimbursement to physicians. The CMS Fact Sheet states: …average payment rates under the PFS [Physician Fee Schedule] will be reduced by 2.93% in CY 2025, compared to the average amount these services were paid for most of CY 2024 This sounds like…
China has been transitioning from a fee-for-service (FFS) payment system to a Diagnosis-Related Group (DRG) payment system for hospitals in various cities. Under the FFS model, hospitals were reimbursed for each individual healthcare service provided, which created incentives to increase the number of services during a patient’s hospitalization. In June 2019, the National Healthcare Security…
A paper from Guadamuz et al. (2024) examines trends in pharmacy closures between 2010-2021. The authors use data from the National Council for Prescription Drug Programs (to describe US retail pharmacies), National Center for Health Statistics (to describe population characteristics at the county level) and the American Community Survey (to describe populations at the ZIP…
That is the clever title of recent American Economic Review publication by Cyrus Aghamolla, Pinar Karaca-Mandic, Xuelin Li, Richard T. Thakor. The abstract is below. This study examines the link between credit supply and hospital health outcomes. We use bank stress tests as exogenous shocks to credit access for hospitals that have lending relationships with…
Last week, the Federal Trade Commission (FTC) increased their required premerger reporting requirements for any healthcare providers such as hospitals. Healthcare Dive reports: Thursday’s update marks the first time the FTC has revised its Hart-Scott-Rodino Act premerger notification form in nearly 50 years.The law is intended to alert officials of companies’ intent to merge and…
This questions may be harder to answer than it may seem. While some physicians are fully independent, and others are full employees, other physicians can be affiliated with hospitals, without being hospital-employed. There are various approaches for measuring whether a physician is integrated within a hospital system: Basic TIN-based measure. The standard approach to identifying…
Out of more than 50 alternative payment models (APM) that CMS has implemented only six have shown statistically significant cost savings and only four of these met the requirements to be expanded in duration and scope. That is not my opinion, CMS itself states this. We all want higher quality at lower cost; so the…
As of 2007, about half of physicians had noncompete clauses (“noncompetes” for short) in their contracts. However, a recent FTC rule severely limits when they could be used. What specifically did the new FTC rule say about non-competes? Fuse Brown et al. (2024) provide a helpful summary. The final FTC rule declares all new noncompete clauses or…
Managing multiple medications is a challenge for many individuals, particularly the elderly. One study by Almodóvar et al. (2019) found that among Medicare beneficiaries eligible for medication therapy management (MTM), 51% had used 11 or more medications. One approach to improving medication management is to use an appointment-based model (ABM) and other forms of medication…