Tag Archives: healthcare delivery

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 »

Why Using Social Determinant Metrics in The Hospital Readmission Penalty Calculation Matters?

Currently, there is an ongoing debate whether Medicare readmission penalty policy is equitable to all hospitals. The greatest argument and concern is the lack of social determinants of health (SDOH) factors in the calculation. Many contend including SDOH is essential to create greater equality amongst the comparisons. In contrast, others do not believe they are impactful or state… 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 »

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 »

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 »

Taking a Closer Look at Capitation for Value-Based Care

As we focus on delivering value-based care; higher quality at a more affordable price, the conversation concerning payment models rapidly pivots to global capitation for a population of lives. The opposite payment model is a fee-for-service model, and currently, there is a belief that service-based fees lead to an over-utilization of services. Consequently, many believe the only possible… Read More »