CMS STARS ratings – It’s Time for a Change

In 2016, the Centers for Medicare and Medicaid Services (CMS) introduced the Overall Hospital Quality Star Rating Program to create transparency on hospitals’ quality, by summarizing dozens of metrics on the Hospital Compare website. There was considerable consternation over the validity of the data. In addition to comparing all hospitals to each other, regardless of unique dynamics, all… Read More »

Workforce Wellness Programs: Are They Focused on the Wrong Thing?

Recently, there has been an ongoing debate over the value of workplace wellness programs. It is logical to think that to improve a person’s health, you can provide them with support services such as weight management and disease intervention plans through their worksite and ultimately their health will improve, and costs will decrease for both the employee and… Read More »

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 »