Recently, a colleague shared an article with me, “The Two Words That Can Make Health Care a Nightmare,” by Chris Stranton, highlighting the challenges posed by prior authorizations (PAs) in healthcare. While I agree that PAs can be problematic, it’s crucial to delve deeper, and consider the broader context surrounding their use. Prior authorizations have long been a… Read More »
With enrollment in the Medicare Advantage (MA) program continuing to rise and nearly 50% of all Medicare eligible beneficiaries participating in an MA product, now is the time to evaluate the program’s benefits and possible unintended consequences. Why? A recent study by Landon et al., published in the Journal of the American Medical Association, compared the two programs… Read More »
In healthcare, particularly regarding new technologies, we habitually chase after the latest, greatest shiny object. And we very often accept these innovations as being beneficial even before the data is confirmed, sometimes even failing to terminate usage when it’s not shown to be of benefit. And Remote patient Monitoring (RPM) risks falling into that scenario. Hypothetically, the idea… Read More »
As we continue to focus on the cost of healthcare and delivering value, there has been an ongoing interest in ordering ambulatory testing, especially regarding musculoskeletal complaints. What is driving this cost, is the volume of tests ordered and the unit price of those tests. Undoubtedly, it’s worth spending time discussing the degree of pricing; however, it is… Read More »
In a manner that was not possible during “normal” times, the COVID crisis allowed us to implement much-needed changes and the expansion of virtual care is one of them. In addition to the growth of virtual care, increasing the healthcare workforce during a time of crisis was necessary. In all, 45 states extended licenses to out-of-state practitioners. Currently,… Read More »
Currently, a significant portion of value-based care payments has focused on primary care-based models. Whether Medicare Advantage, Medicare Shared Savings Programs, Direct Primary Care, or other value-based programs, they all center on primary care clinicians and services. Though there are a few unique specialty-based models such as BPCI, the vast majority are not. These models have had a… Read More »
There is considerable discussion regarding aligning incentives to lower the total cost of care, and even more specifically, on the importance of diagnostic testing, the value it might bring, its accuracy, and the shared decision-making when ordering tests. Therefore, aligning incentives around appropriate diagnostic testing is critical to both diagnostic excellence and affordability of healthcare. Additionally, an important… Read More »
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 »
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 »
Almost daily, there are articles addressing the need for healthcare to be more consumer centric. We envision the topic within the context of service, access, and affordability. Yet, there remains a component that encompasses how we engage those we serve from a clinical perspective. Diagnosing and treating has been the primary focus of clinicians’ training. But, as we… Read More »