Margalit Gur-Arie

Margalit Gur-Arie is founder, BizMed. She blogs at On Health Care Tech & Policy.

Tomatoes, ketchup, and direct primary care

Policy

April 28, 2015

According to OECD data, Americans see doctors less frequently than people in any developed nation. We are hospitalized less frequently, and we stay in the hospital less time than citizens of other nations. The vast majority of Americans, more than any other nation, describe themselves as healthy, and America has the largest percentage of young people in its population. So why is health care in America so much more expensive …

Why not turn our health care disaster into an opportunity?

Margalit Gur-Arie

Policy

April 20, 2015

Health care in America is a perfect example of the Pareto principle, because 80 percent of our gargantuan expenditures on health care are due to only 20 percent of us who are very sick, elderly, disabled and vulnerable in many other ways.

If we genuinely wished to reduce health care expenditures, common sense dictates that we would leave the 80 percent alone and zero in on those 20 percent, trying to …

What does meaningful use stage 3 mean to you?

Margalit Gur-Arie

Tech

April 10, 2015

On March 20, 2015 the stars aligned to produce four simultaneous events that will never again coincide during the life of human civilization. The first three, the vernal equinox, a total solar eclipse and a new supermoon, were brought to us by the stars themselves, and the fourth one was thrown out there by the government. The regulations for meaningful use stage 3 were finally published. Meaningful use of electronic health …

Health care consumer products need not contain real doctors

Margalit Gur-Arie

Policy

March 28, 2015

One of the most revolting pleasures in life is to read learned opinions and in-depth analyses of consumers’ behavior written by beautiful people clad in designer clothing, dining at eclectic chic trattorias or enjoying the occasional canapé under crystal candelabra at their favorite charity gala. These wondrous creatures, having pored over a few disjointed numbers selectively allowed to escape from our struggle with health care, are informing us that there …

The transition to value-based care: Think Starbucks

Margalit Gur-Arie

Policy

March 10, 2015

Whether you like it or not health care financing is transitioning from payment for discrete services to global payment for value. Whether you agree with this trend, or comprehend its meaning, if it has one, is largely irrelevant in the short term. The government of the United States, the Chamber of Commerce, both political parties, all health care stakeholders, and even your own medical associations are fervently supporting, and actively …

Primary care physicians: Fight for your value

Margalit Gur-Arie

Policy

February 22, 2015

There are close to a quarter million primary care physicians in the U.S., more than any other individual specialty, and about half the total number of all specialists combined. Yet, somehow, primary care seems to lack the power and social influence necessary to chart its own professional course. As the availability and granularity of specialist physicians increased, the value proposition of a generalist primary care doctor seems to have become unclear to …

Whither the physician? The future of primary care.

Margalit Gur-Arie

Policy

January 23, 2015

You may not be ready to admit it even to yourself, but you know it’s changing. Permanently. Some say it’s for the better. Others say it’s for the worse. Most don’t really care much one way or the other. After all, health care has been evolving and changing over thousands of years, and the experts best positioned to evaluate the health care turmoil of our times are yet to be …

Physicians must unionize. Here’s why.

Margalit Gur-Arie

Physician

January 12, 2015

shutterstock_22140319

If F. A. Hayek were alive today, he would support the revival of labor unions in general and professional labor unions in particular. Towards the end of the Second World War, Hayek wrote a book warning us all that allowing governments to engage in extensive central planning of economic activities is nothing more than a road to serfdom for humanity. F.A. …

Read more…

Physicians must unionize. Here’s why.

Jonathan Gruber: What if he’s right?

Margalit Gur-Arie

Policy

December 11, 2014

So there is this guy from MIT or Harvard, or some other place where they teach our leaders how to lead, and his name is Jonathan Gruber. Mr. Gruber, it seems, was hired to consult with the Obama administration during the time the Affordable Care Act (ACA) was created because of his extensive expertise in designing the Massachusetts health care system. In recent weeks, people who don’t particularly like our …

Read more…

Jonathan Gruber: What if he’s right?

EMRs remove the soul of the medical record. So, what’s next?

Margalit Gur-Arie

Tech

November 26, 2014

shutterstock_130682090

By the time the next decade rolls in there will be no paper charts. There will probably still be paper floating around in various capacities, but there will be no one charting on paper. The term “charting” itself may become obsolete, like yonder or popinjay. The term EHR, which is what replaces the paper chart, won’t last either because it doesn’t …

Meaningful use: The independent majority can stop the madness

Margalit Gur-Arie

Tech

November 17, 2014

According to the American Medical Association, there were approximately 685,000 physicians in patient care, post-residency, not employed by the federal government, in 2012. 60 percent of these physicians practiced in independent private practice, and 84 percent were working in small to medium size practices. Assuming that the trend to employment of doctors by health systems continued unabated to this day, over half of practicing physicians are still in private practice and …

Open Payments: Detailing the media’s witch hunt

Margalit Gur-Arie

Policy

October 14, 2014

Physicians, whether practicing medicine or not, should not be involved in clinical research. They should never be consulted on development of new drugs and medical devices. Doctors should not invent new treatments, and should never supervise clinical trials. They should not travel to or speak at conferences either, and they should banish all entrepreneurial notions out of their heads. If they insist on engaging in these activities, they should do …

Who is blocking EMR interoperability? You are.

Margalit Gur-Arie

Tech

October 7, 2014

shutterstock_203013685

The Senate Appropriations Committee has defined a new transgression perpetrated in the committee’s expert opinion by vendors of certified EHRs, as well as “eligible hospitals or providers.” Since the committee has no data or evidence of any kind that this transgression is actually occurring, it requires the Office of the National Coordinator for Health Information Technology (ONC) to embark on a fishing expedition …

Who are the best judges of physician quality?

Margalit Gur-Arie

Physician

September 21, 2014

In a new Forbes article, David Shaywitz ponders whether patients are the best judges of physician quality. This is a very interesting question, not because the answer is elusive, but because the question itself is rather unusual, and may prove to be the harbinger of a new way of thinking about health care. The question raised by Dr. Shaywitz is not whether patients …

Value-based care: Bad for doctors, bad for patients?

Margalit Gur-Arie

Policy

September 11, 2014

Value-based health care is antithetic to patient-centered care. Value-based health care is also diametrically opposed to excellence, transparency and competitive markets. And value-based health care is a shrewdly selected and disingenuously applied misnomer. Value-based pricing is not a health-care innovation. Value-based pricing is why a plastic cup filled with tepid beer costs $8 at the ballpark, why a pack of gum …

The study you never heard of: Small practices aren’t dead yet

Margalit Gur-Arie

Policy

September 5, 2014

According to a new Commonwealth Fund sponsored study published in Health Affairs, “Small Primary Care Physician Practices Have Low Rates Of Preventable Hospital Admissions.” The study of over one thousand practices of various sizes and ownerships, conducted by some of the most respected names in health care, found that the smallest independent primary care practices, that are physician owned, provide better care …

Go ahead, let’s just make poverty a disease

Margalit Gur-Arie

Policy

August 22, 2014

In a previous post, I described how the American health care system is morphing into a system designed to service impoverished populations, and concluded that the transition “will take time, thoughtful planning, lots of innovation and a carefully cultivated disdain for human life.”

However, a new blog post from Dr. Peter Ubel makes me think that it may not take that much time after all. It seems that Dr. Ubel …

Hypoliquidemia has now come to health care

Margalit Gur-Arie

Policy

July 29, 2014

The venerable University of Texas MD Anderson Cancer Center in Houston will accept patients with traditional Texas Medicaid health insurance, and some patients in Medicaid managed care plans. Memorial Hermann, another large health system in Houston, will accept traditional Medicaid patients and also those in Medicaid managed care plans. Neither institution will accept the Blue Cross Blue Shield HMO silver plan sold on the Affordable Care marketplace, according to Read more…

Hypoliquidemia has now come to health care

Digging deeper into the Commonwealth Fund health rankings

Margalit Gur-Arie

Policy

July 22, 2014

The Commonwealth Fund just published its fourth Mirror, Mirror on the Wall study comparing the U.S. health care system with other countries, and as in all previous studies, we ranked as the absolutely worst health care system in the developed world, bar none.

Yikes.

The Commonwealth Fund studied many health care domains, and we didn’t rank in first place for anything. The best we managed to do is place a lackluster third …

Health care for the poor: A race to the bottom

Margalit Gur-Arie

Policy

July 4, 2014

There are over 16,000,000 American children (21.8%) who live in official poverty and double that number who are just poor. This is not happening in an obscure country, in a continent far away. It is happening right here, across the street from you. For those enjoying a good episode of Duck Dynasty, these are not children of illegal immigrants, and the vast majority is white kids.

Over 44,000,000 American children (more than 1 …