Tag Archives: healthcare distribution

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 »

Is Evidence-Based Medicine Being Used in Drug Step Therapy?

Pharmaceutical costs continue to rise and are increasingly becoming a significant portion of medical spending for care. There have been many attempts to stem this ever-increasing portion of the total cost of care including, increased generic utilization, value-based incentive models, and the use of drug step therapy protocols. Specifically, this latter model requires the administration of specific agents… Read More »

When Should We Stop Certain Regulations?

In healthcare, we have become accustomed to ongoing Medicare regulatory oversight and changes. Many of these regulations are implemented to drive specific behaviors that are focused on improving quality and/or reducing costs. One such measure is the Medicare Two-Night Rule. This rule, created in 2013, was designed to replace the inappropriate inpatient admission status stays with what they… Read More »

Taking a Deeper Look at Inequity within Our Scientific Process

As we continue to address health inequities, we must also consider underlying structural issues. If I am to deliver care focusing on equity, the basis for my treatment must be grounded in science. However, if my science is flawed due to underlying systemic biases and flaws in study design, we will never progress. Since inequities are pervasive and… 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 »