Niran S. Al-Agba, MD

The CVS-Aetna merger: millions of lives hang in the balance

January 10, 2018Jan 10, 2018

Recently, pharmacy giant CVS agreed to purchase Aetna for an astounding $69 billion dollar sum. The company allegedly plans to reduce health spending by developing an integrated system touted as “a new front door for health care in America.” This merger is actually an acquisition, entailing transfer of ownership. The central aim of an acquisition is to increase market share, expand the scope of services provided, and improve financial …

It’s time to speak with a collective voice: Why doctors should unionize

October 31, 2017Oct 31, 2017

Since the birth of our nation, labor unions have existed in one form or another in the United States. Unions are a force to protect the "working population" from inequality, gaps in wages and a political system failing to represent…

Since the birth of our nation, labor unions have existed in one form or another in the United States. Unions are a force to protect the “working population” from inequality, gaps in wages and a political system failing to represent specific industry groups. Historically, unions organize skilled workers in a specific corporation, such as a railroad or production plant. However, unions can organize numerous workers within a particular industry. Known …

Feel over-boarded by MOC? Fight back.

October 22, 2017Oct 22, 2017

According to recent Ohio statistics, 1.3 million people have limited or no access to primary care physicians. Based on the 2015 Ohio Primary Care Assessment, 60 of 88 Ohio counties have medically-underserved populations. The Patient Access Expansion Act (HB 273), co-sponsored by Representative Theresa Gavarone (3rd District) and Representative Terry Johnson (90th District), specifically addresses health care access by prohibiting physicians from being required to comply with maintenance of certification …

Feel over-boarded by MOC? Fight back.

Do physicians deserve our mercy? #silentnomore

October 19, 2017Oct 19, 2017

Recently, a video went viral when a woman complained about the lengthy wait time at a clinic. On video, we see the physician asks if the patient still wants to be seen. The patient declines to be seen, yet complains…

The frustrated physician replies, “Then fine … …

Why immunization rates should not be used as a quality indicator

October 19, 2017Oct 19, 2017

As policy experts cling to pay-for-performance (P4P) as an indicator of health care quality and shy away from fee-for-service, childhood immunization rates are being utilized as a benchmark. At first, glance, vaccinating children on time seems like a reasonable method to gauge how well a primary care physician does their job. Unfortunately, the parental vaccine hesitancy trend is gaining in popularity. Studies have shown when pediatricians are specifically trained to counsel parents on …

The story of how a hospital is being sacrificed for money

September 20, 2017Sep 20, 2017

There is a 4,300-strong grassroots movement known as “Save Our Hospital” gaining notoriety in Albert Lea, Minnesota. This story is symptomatic of the fact that hospital consolidation has slowly become a national pastime. With declining revenue under the Affordable Care Act, mergers increased by 70 percent, leaving small communities scrambling for health care access. The latest casualty in the “hospital-consolidation-for-sport” trend is Albert Lea, a small …

Health reform is stalled. Here’s how to do it right.

August 5, 2017Aug 5, 2017

I told you so. I also told the POTUS in my open letter, but he did not read it. Who could honestly believe the nation would support dumping coverage for 22 million people? As David Leonhard wrote recently op-ed in…

I told you so. I also told the POTUS in my open letter, but he did not read it.

Who could honestly believe the nation would support dumping coverage for 22 million people? As David Leonhard wrote recently op-ed in the New York Times: “They [Republicans and President Trump] had only one big weakness, in fact: They weren’t dealing in reality.” When faced with reality, it is interesting what a few good …

The unexpected impact this patient had on his pediatrician

June 29, 2017Jun 29, 2017

As a pediatrician, I work to keep children healthy so they can grow up and achieve their dreams. Occasionally, my naïve optimism has gotten the better of me. I especially have a soft spot for angry, defiant children. These children are given my undivided attention and respect, and I expect the same in return. I never call them names, insult them, or label them. On the contrary, I have high …

Is direct primary care doomed to fail?

June 19, 2017Jun 19, 2017

A recent Medical Economics article asked “Is the DPC model at risk of failing?” The piece focuses on two large DPC-like organizations, Qliance Medical Management of Seattle, Washington and Turntable Health of Las Vegas, NV, working in partnership with Iora…

A recent Medical Economics article asked “Is the DPC model at risk of failing?”

The piece focuses on two large DPC-like organizations, Qliance Medical Management of Seattle, Washington and Turntable Health of Las Vegas, NV, working in partnership with Iora Health, which recently closed their doors. Qliance and Turntable were not actually DPC practices by strict definition; they were innovative large business operations providing health care services to patients and excluding …

Is direct primary care doomed to fail?

MD vs. DNP: 20,000 hours make a difference

June 6, 2017Jun 6, 2017

As Southern states entertain legislation granting nurse practitioners independent practice rights, there are some finer details which deserve careful deliberation. While nurse practitioners are intelligent, capable, and contribute much to our healthcare system, they are not physicians and lack the same training and knowledge base. They should not identify themselves as “doctors” despite having a doctor of nursing practice (DNP) degree. It is misleading to patients, as most do not …

Listen up GEHA: Vaccines should not be an out of pocket cost

May 29, 2017May 29, 2017

In a little piece of legislation known as the Affordable Care Act, preventive services are mandated to be covered with no out-of-pocket expense to consumers. According to the Healthcare.gov website, approved insurance plans must cover a “list of preventive services…

Number 18 on that preventive care list is childhood immunizations for children from birth to age 18, acknowledging regional variation in the standard …

Dear President Trump: What you should do about your health care plan

May 15, 2017May 15, 2017

I hope you read this letter. I doubt you will. I know you’re busy rebuilding Washington, reshaping the international order and doing a lot of other weighty stuff. Full disclosure, I voted for you. Not because you promised to repeal the Affordable Care Act, or because you tweeted at me about it, but because our health care system is hopelessly broken and requires an overhaul that does not simply convert …

Are nonprofit hospitals a fairy tale?

May 8, 2017May 8, 2017

Nonprofit hospitals have higher profit margins than most for-profit hospitals after accounting for their tax obligations. 3900 (62 percent) of U.S. Hospitals are nonprofit and therefore tax-exempt — they pay no property tax, no federal or state income tax and no sales tax. An article published in Health Affairs found seven of the nation’s 10 most profitable hospitals were of the nonprofit variety, each earning …

Are nonprofit hospitals a fairy tale?

Facility fees are ruining quality care

May 1, 2017May 1, 2017

The Affordable Care Act Medicaid expansion resulted in unanticipated negative consequences for many patients and physicians in rural, underserved or medically isolated communities across America. Consolidation of health care entities was financially incentivized by the ACA, and slowly my beloved…

In a beautiful community on the Olympic Peninsula, just north of where I live and practice, it happened again; another private …

Facility fees are ruining quality care

You’ve heard of Brexit? Here’s what they call doctors who are leaving.

April 25, 2017Apr 25, 2017

Sean MacStiofain said, “most revolutions are caused … by the stupidity and brutality of governments.” Regulation without legitimacy, predictability, and fairness always leads to backlash instead of compliance. Here’s a prediction for you: If something is not done to stop…

Here’s a prediction for you: If something is not done to stop MACRA implementation, more physicians will opt-out of Medicare and Medicaid than is fathomable.

Once DRexit begins, there will be no turning back.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is …

Hospital mergers don’t work

April 14, 2017Apr 14, 2017

There is a growing body of evidence that hospital mergers lead to higher prices for consumers, employers, insurance and the government. It is imperative to educate patients and lawmakers as to how the consolidation of hospitals and medical practices raise costs, decrease access, eliminate jobs and, ultimately, reduce care quality as a result. Lawmakers should focus on this “first pillar” of cost control as they go back to the drawing …

Hospital mergers don’t work

United Airlines should do more than apologize profusely #BoycottUnited

April 13, 2017Apr 13, 2017

Watching events unfold at United Airlines over the last few days have filled me with shock, awe, and horror. As a result of this public relations disaster, their motto “flying the friendly skies” has turned into “not enough seating, prepare for a beating.” America stands as a beacon of freedom from oppression. United Airlines was an iconic American company until last Sunday, with a responsibility to uphold the intent of …

Politicians must consult front-line physicians for health reform

April 11, 2017Apr 11, 2017

Recently, the AHCA was pulled from the House floor after not enough votes could be secured in favor of its passage. A Washington Post article reported President Trump’s thoughts on the matter: “We couldn’t get one Democrat vote, not one.…

Journalist Robert Costa asserted “there was little evidence that either Trump or House Republicans …

The problem with price transparency

March 26, 2017Mar 26, 2017

Transparency -- including price, quality, and effectiveness of medical services-- is a vital component to lowering costs and improving outcomes. However, it is imperative transparency go hand-in-hand with financial incentives for patients and consumers; otherwise, the quest will be in…

Transparency — including price, quality, and effectiveness of medical services– is a vital component to lowering costs and improving outcomes. However, it is imperative transparency go hand-in-hand with financial incentives for patients and consumers; otherwise, the quest will be in vain. The single best way of reducing costs while not worsening health outcomes is to redistribute resources from less cost-effective health services to more cost-effective ones. Americans are extremely uncomfortable …