The dialysis industry is a microcosm of what ails the health care system

Policy
July 26, 2016

If you want to understand what ails the U.S. health care system, look no farther than the dialysis industry. A recent New York Times article, “UnitedHealthcare Sues Dialysis Chain Over Billing,” provides a pre-made case study.

In brief, a chain of dialysis clinics, American Renal Associates, pushed poor people out of government coverage and into private insurance with UnitedHealthcare so that the clinics could bill $4,000 per treatment rather than $200. A …

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The dialysis industry is a microcosm of what ails the health care system

Should patients be responsible for physician handwashing?

Patient
October 12, 2013

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Hospitals struggle to get doctors and nurses to wash their hands. That’s a serious problem, since hand washing is one of the keys to reducing healthcare acquired infections that afflict more than a million patients a year and kill over 100,000. And it’s one of the reasons you should try your best to stay out of the hospital.

For the past few years …

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Should patients be responsible for physician handwashing?

The state of online doctor ratings: It’s still early

Physician
April 24, 2013

A front-page Boston Globe article on a neurosurgeon suing a caregiver for a harsh blog post  is exciting but unrepresentative of the overall state of online doctor reviews. However it caused me to take another look at online physician ratings from the perspective of someone trying to find a doctor.

Conclusion: we are still in the early days and there is plenty of opportunity for better, more useful information. …

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The state of online doctor ratings: It’s still early

The nursing shortage: Why it isn’t a good time to become a nurse

Policy
February 7, 2013

For years we’ve read that the US faces a looming shortage of nurses. Shortfalls in the hundreds of thousands of nurses are routinely predicted. These predictions have been good for nursing schools, which have used the promise of ample employment opportunities to more than double the number of nursing students over the last 10 years, according to CNN.

Yet somehow 43 percent of newly-licensed RNs can’t find jobs within …

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The nursing shortage: Why it isn’t a good time to become a nurse

What does the Explanation of Benefits really mean?

Patient
October 12, 2011

I recently had some physical therapy for a minor injury. Since the office forgot to charge my co-pay the first time I went in I received a so-called Explanation of Benefits (EOB) from my insurance carrier, BlueCross BlueShield of Massachusetts.  EOBs are a holdover from the mainframe era: arcane, inflexible reports that are hard to interpret. They may have done their job in the day when their only purpose was …

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What does the Explanation of Benefits really mean?

Medical malpractice doesn’t address patient safety

Policy
July 24, 2011

Medical malpractice reform is one of the few health care policy issues where there is a real possibility of agreement between the White House and Congress. A common refrain is that the fear of lawsuits leads physicians to practice defensive medicine, ordering too many tests just to cover their behinds in case of a lawsuit. It drives up costs without creating benefits. There’s some truth to this argument, …

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Medical malpractice doesn’t address patient safety

Should a hospitalist be given more information on hospital costs?

Physician
April 27, 2011

In Today’s Hospitalist, Jeremy Graham, DO discusses implications of research he’s published about hospitalists and costs: How much is that bed on the ward? Hospitalists are clueless about patient charges.

Not surprisingly, hospitalists, like almost everyone in the hospital, have no idea what anything costs.

That’s no real shock, as Graham points out:

It’s often hard for hospitalists to know these charges, …

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Should a hospitalist be given more information on hospital costs?

Treatment guidelines pros and cons

Conditions
February 17, 2011

I was puzzled by a Health Affairs article showing the public finds arguments against treatment guidelines a lot more compelling than arguments in favor. But after reading the technical appendix, which contains the full text of the survey, I think the problem is that the researchers framed the question poorly. In particular, the researchers portrayed guidelines as unrealistically rigid.

In A National Survey Reveals Public Skepticism About Research-Based Treatment …

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Treatment guidelines pros and cons

Cutting costs under the guise of patient safety

Policy
December 14, 2010

Rationing is a very dirty word in America, evoking grim images of wartime Great Britain and, in the health care context, withholding of needed care from patients based on cost. But cut back on costs we must, and with magical thinking about the deficit becoming every more popular, we’ll have to find other ways to convince folks to do it.

Patient safety is a promising guise under which to achieve cutbacks, …

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Cutting costs under the guise of patient safety

Comparative effectiveness research needs to be taught to doctors and patients

Physician
October 28, 2010

Oncology is the area where the health care cost conundrum is coming into sharpest focus. Theoretically, who wouldn’t spend whatever it takes to cure a life-threatening disease? And yet practically the costs of new treatments are so high, and the improvements usually modest enough, that when it comes right down to it costs are becoming a real issue for patients and doctors.

An interesting article in the Journal of Clinical Oncology …

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Comparative effectiveness research needs to be taught to doctors and patients

Is health care shifting towards convenient retail clinics?

Physician
September 13, 2010

Mark Perry provides an interesting inference from two news stories: a WSJ article that suggests consumers are using less health care and another that reports a big jump in MinuteClinic volumes.

Consumers aren’t necessarily consuming less health care like the WSJ suggests; rather, they are shifting their demand for health care away from expensive, conventional physician offices with limited hours to affordable and convenient retail clinics.  Especially …

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Is health care shifting towards convenient retail clinics?

Medicare needs to take the lead for health care cost control

Policy
August 12, 2010

One of the big complaints about the recently enacted health care reform law is that it does little to control costs. There is some truth to that because the major focus is on increasing access to insurance. And yet there is reason for optimism on a couple of fronts:

  • First, with many of the access issues settled, stakeholders can focus directly on cost matters rather than cost-shifting and finger pointing
  • Second, health …

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Medicare needs to take the lead for health care cost control

Practical barriers for comparative effectiveness studies

Policy
July 10, 2010

Writing in the New England Journal of Medicine three authors share their experience in running a head-to-head trial of Avastin (bevacizumab) versus Lucentis (ranibizumab) for wet age-related macular degeneration (AMD).

They describe the barriers they faced and suggest that the barriers will need to be removed for comparative effectiveness research to succeed. They make good points and may well be correct in their policy recommendations.

However the case of Avastin and Lucentis …

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Practical barriers for comparative effectiveness studies

Medical loss ratios is not all about health insurance profits

Policy
June 14, 2010

The new health insurance reform law will generally require health plans to pay out at least 80 or 85 percent of premiums in medical expenses, depending on whether they are selling to individuals/small groups or to large groups. Intuitively it makes sense that purchasers would want the medical loss ratio to be as close to 100 percent as possible –- since the purchaser doesn’t derive utility a plan’s administrative expenses …

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Medical loss ratios is not all about health insurance profits

When will cost effectiveness ever be acceptable in US healthcare?

Policy
May 24, 2010

Cancer. The Big C. No one wants money to stand in the way of curing a patient.

But real life is messier. Many new treatments for cancer are pricey yet provide only marginal gains over existing therapies in life expectancy and/or quality of life. Forty thousand dollars for a cure is not a real dilemma for policymakers — the same spend for an extra six weeks of life is another story.

In …

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When will cost effectiveness ever be acceptable in US healthcare?

How Massachusetts controls health costs should be closely watched

Policy
May 5, 2010

A major criticism leveled at the health reform law is that it doesn’t do enough to control costs. Yet experience with a similar breed of health reform in Massachusetts indicates that the cost control issue will come to the fore sooner rather than later.

Recent stories have reinforced my conviction about this:

Massachusetts health plans have sued the state and stopped issuing new policies to small businesses and individuals after the …

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How Massachusetts controls health costs should be closely watched