Category Archives: Blog entry

Physician Practices with Robust Capabilities Spend Less on Medicare Beneficiaries

As consolidation and integration of physician practices occur, especially within organizations that can wrap capabilities around ambulatory clinical care, we must examine the potential benefit to those we serve. This ideal is also the premise for a clinically integrated network where payment models are designed to allow for enhanced capabilities available to smaller groups of clinicians. These enhanced… Read More »

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 »

The Value of an intellectual vs Emotional Approach to the Root Causes of Health Inequities

As we focus on improving the care for all, with a lens toward health equity, it’s essential to examine the root causes of health inequities and their existence. And Racism is a contributing factor that has led to our present situation. To progress, we need to have an understanding and commonality of definitions. Referencing a recent article by… 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 »

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 »