Understanding Why We Need Stratification of Hospitals for Readmission Penalties

There has been considerable debate concerning the value of the Medicare Hospital Readmissions Reduction Program. The program was designed to deduct up to 3% of Medicare payments for hospitals with higher-than-expected thirty-day all-cause readmission rates, after index admissions, for six conditions and procedures. One of the primary concerns regarding the program was the disproportionate impact on teaching and… Read More »

The Value of Nonprofit Hospitals

There has been a great deal of focus on whether nonprofit hospitals bring value to the communities they serve in proportion to their tax-exempt status. The argument is that the tax dollars are necessary and properly utilized for community benefit; therefore, a tax-exempt status requires community benefit in replacement of payments. The measure used as a metric for… Read More »

Do Value Based Payment Models Really Work?

For those in the value-based payment (VBP) world, we are constantly asking the question; “Is what we are doing impactful and adding value to quality, service, and costs, to those we serve?” A recent study in Health Affairs analyzed 20 years of commercial VBP studies and found mixed results. And from this information, it’s possible to formulate a… Read More »

A Deeper Look at Structural Racism in US Health Care Policy

Structural racism refers to, “The totality of ways societies foster racial discrimination through mutually reinforcing systems of housing, credit, media, health care, and criminal justice.” One of the leading structural components that has led to the inequitable distribution of health services is healthcare financing, i.e., insurance coverage. Inadequate health insurance coverage is one of the most prevalent barriers… Read More »

Changing the Language We Use for A Transient Ischemic Attack

In the past, those who had a transient episode of cerebral ischemia, marked by symptoms that resolved quickly, were informed they had a Transient Ischemic Attack (TIA). Over time, this was translated by the lay population as a “mini-stroke” or “almost a stroke.” And, consequently, these events became minimized as they were deemed “not that bad.” Unfortunately, recent… Read More »

A Look at the Progression of Value-Based Payment Models

For those in the value-based world, we have been on this journey for years. And we have witnessed and participated in CMS and CMMI creating and implementing various models.  Undoubtedly, some have been more successful than others, and there has been an ongoing debate concerning the impact on value-based payment models. Two of the major concerns that have… Read More »

Embracing the Invisible Workforce

Currently, we are at a crossroads in our workforce when it comes to the care required for those we serve.  Especially when it comes to situations when family members and friends are delivering care upon hospital discharge. There is also the dynamic of the same type of service provided while a loved one is in the hospital and… Read More »

Using Artificial Intelligence in a Manner that is Helpful

In all honesty, I am exhausted over the conversations regarding Artificial Intelligence (AI). It is the latest shiny new object. However, those of us that have been utilizing it are disappointed with the results. This displeasure is occurring for numerous reasons, beginning with the reality that we are early on, in the development of AI for healthcare. Additionally,… Read More »

A Bell-Shaped Curve and Healthcare Grading

Healthcare is brimming with competitive clinicians and administrators. CMS and other “grading” agencies pit us against each other concerning benchmarking, penalties, and value-based payments. But does this methodology promote better patient care? Most of our quality and experience metrics are “graded” on a bell-shaped curve; in other words, how we do, compared to others? This constant analysis leads… Read More »