Tag Archives: cost of healthcare

Should Physician Offices Be Bill Collectors?

In our present financial models of healthcare reimbursement, the setup frequently places the physician and their practice staff in a real predicament. Consumers request that they deliver care during their time of need in a reverent and life-giving manner.  Additionally, they are required to collect your co-pay and/or co-insurance while simultaneously understanding your benefit plan, including how much… Read More »

Healthy Equity is A Critical Part of Value-Based Payment Models

As value-based payment models have continued to expand, this expansion has occurred in the more affluent communities. Additionally, communities with more socioeconomically vulnerable individuals were less likely to be selected for joint replacement bundles, another form of a value-based payment. A big reason for this lack of equitable distribution of value-based care, can be linked to the absence… Read More »

How Do We Support Primary Care?

Primary care in the United States accounts for more than one-half of all outpatient visits. Moreover, regardless of the clinical models, primary care is at the core. Unquestionably, primary care is at the center of health equity and preventive care. However, it receives a relatively modest proportion of resources, possesses no federal coordinating capacity, no dedicated research support,… Read More »

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 »

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 »

Healthcare Can Be More Affordable if We Can Limit Waste

The cost of healthcare in the United States is exorbitant. There are multitudes of reasons for our elevated unit price. Many believe, waste, makes up a significant part of the problem. And the largest component of wasteful spending is what we identify as administrative costs. These are dollars that are not improving patient care, and yet, they impact… Read More »

Exploring Quality as the Use of Virtual Care Expands

The COVID-19 pandemic has elevated the speed at which we have converted to virtual care. Physicians and consumers have substantially increased their use of virtual visits and digital applications. This care includes interactions concerning diagnosis, evaluation, and management of conditions that historically have occurred in person. Because of this, many questions arise concerning the quality and utilization of… Read More »

Are People Willing to Pay Extra for Quality?

There are several external rating agencies such as CMS STARS, Healthgrades, Leapfrog, and US News and World Report that inform the public concerning the quality of healthcare facilities and physicians. Unfortunately, many of these rating agencies rarely measure the same metrics, so it can be extremely confusing both for the provider and the consumer to decipher. And being… Read More »