Unbiased Analysis of Today's Healthcare Issues
Medicare’s Merit-based Incentive Payment System (MIPS) aims to link physician quality of care to their reimbursement. At first glance, paying more to high quality physicians seems like a great idea. However, a paper by Liao et al. (2018) surveys physicians from a large national sample maintained by the American College of Physicians (ACP). They find…
Conventional wisdom holds that in recent years the answer is ‘yes’, however what does the data show? A paper by Nipay, Richards and Penso (2018) uses an SK&A survey of physician office practices between 2007 and 2017 to find the answer. In short, conventional wisdom is largely true with the caveat that there is significant…
A number of studies have suggested that we are spending too much on end of life care. Consider this Kwok et al. (2011) study published in Lancet. Many elderly people in the USA undergo surgery in the year before their death. The rate at which they undergo surgery varies substantially with age and region and…
How do physicians learn? A paper by Van Gestel, Muller, and Bosmans (2018) claims that the answer is through cumulative experience, economies of scale, or human capital depreciation. Learning from cumulative experience refers to the idea that treating an additional patient generally improves physician (or team) performance. When referring to economies of scale, we capture…
The effect of health care industry consolidation on prices is a question argued about by many including researchers, economists, anti-trust, lawyers, regulators and more. There is evidence that health plan consolidation increases premiums, and hospital consolidation increases price. For instance, Dafny et al. 2015 writes: The harsh reality is that it’s difficult to find well-documented…
Many of Medicare’s alternative payment models are based on the premise that there is a lot of waste in health care. If that is the case, we could reduce cost with little to no effect on quality. While that would be nice, is that really the case? Consider two articles from the most recent edition…
How is President Trump planning to keep his campaign promise to improve health care for Veterans? One pathways is through his VA Mission Act of 2018. As the Washington Post reports, this bill would include $55 billion in additional funding for veterans. A key part of this legislation is that it allows for more veterans…
Although this study about 18 months old, I just came across this and the findings were really surprising. During the office day, physicians spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on EHR and desk work. While in the examination room with patients, physicians spent 52.9%…
Not all medical problems can or should be treated by a nurse practitioner (NP). However, may can be. Increasing access to care through NPs can reduce wait times through expanding access and decrease cost. The access and cost issues are not in doubt; the question is, can NPs improve or at least maintain patient care? …
One idea is to provide additional funding for both formal and informal caregiving services. For instance, one could subsidize nursing homes or home health agencies on the formal side; for informal caregiving, one could give stipends to individuals to care for their elderly parents. The question is, does this implementation actually work? This is the…