Understanding the Design Characteristics of Primary Care Capitation

Capitation, as a value-based payment model, has been around for decades. Many of us have experimented with variations of capitation, ranging from full capitation for all healthcare services to specialist capitation, to primary care (PCP) capitation. Currently, Primary Care Clinicians are much more comfortable with the nuances of these models because of the expansion of Medicare Advantage. This… Read More »

Taking a Look at What Causes Low-Value Care

Low-value care is defined as the utilization of health services that harm or in which the costs outweigh the possible benefits and there are many reasons for these actions. The desire for clinicians to eliminate situations that might cause harm is a driving factor. Although they may be unable to inform you of precisely what is occurring in… Read More »

There is Wastefulness in a Vial, But We Can Do Better

As we continue to examine areas of excessive waste to enhance affordability, it’s crucial to put all areas under the microscope, including pharmaceuticals. Though convenient, single-dose injection vials lead to wasted medication. In fact, in 2018, the Centers for Medicaid & Medicare Services (CMS) reportedly paid $725 million for discarded drugs administered in hospital outpatient clinics and physician… Read More »

Finally, The Elimination of State Lines

One of the major issues concerning physician licensure is that a physician’s right to practice ends at the state border, regardless of their ability or the needs of others. When we examine areas where there are physician shortages, we see significant differences by geographic location. This shortage might be drastically different if we considered the problem through the… Read More »

Where Do Conflicts of Interest Exist in the Medical Profession?

We hear about conflicts of interest on the news all the time. And in medicine, we have addressed this topic in relation to the pharmaceutical industry and its interactions with physicians. As a result, one can now review these connections as part of the ever-increasing desire for transparency. However, as technology progresses, we must also be attuned to… Read More »

Does the Usage of Telemedicine Visits Increase Follow-up Visits?

During the COVID pandemic, in-person visits were not recommended so telemedicine rapidly evolved into an ideal way of delivering care safely and expanding access while reducing exposure to pathogens to both patients and staff. And tremendous enthusiasm exists for the continuation of such a model. There is no doubt that there is a significant enhancement to access with… Read More »

Does the Usage of Urgent Care Centers Decrease the Total Cost of Care?

We continue to evaluate the value of various care sites, and part of this is considering whether or not the Emergency Department (ED) is overutilized for non-emergent services. Since Urgent Care Centers can provide services at a lower price point, the intuitive solution is to shift care to those facilities. Thus, there is a conundrum of whether it… Read More »

Does the Employer-Provider Direct Payment Program Lower Episode Costs?

Bundled payments for episodes of services such as joint replacements are not a new concept. Throughout the years, the Centers for Medicare & Medicaid Services (CMS) have experimented with Bundled Payment Programs with limited success. After factoring in bonus payments to providers, the net savings to Medicare has been minimal, and on the positive side, there is no… Read More »

The Physician’s Role in Addressing Social Determinants of Health

As a physician, I was taught to diagnose and treat. Sure, I knew your social situation outside of my office played a role in your overall wellbeing, but it really was not in my differential diagnosis. Undeniably, I did what I could to help with those situations, but only within the context of increasing the ability of the… Read More »