“In most countries with universal health insurance, physicians are paid on a fee-for-service basis, yet prices there are lower than in the US. As Miriam Laugesen and Sherry Glied explain, “Higher fees, rather than higher practice costs, volumes, or tuition expenses, are the main driver of higher US spending.” Among US policy makers, the response has been to focus on market competition, managed care, price transparency, and performance measurement. This response is grounded in the view that fee-for-service private practice and third-party payment saddle the health system with perverse financial incentives. Beginning in the 1970s, managed care emerged as a … Read More
All posts by Anupam
“We performed a retrospective, population-based cohort study of US allopathic and osteopathic physicians practicing in 2014 per the National Plan and Provider Enumeration System, excluding other clinicians (eg, nurses, dentists) and physicians activating or deactivating their records between 2014 and 2018. Specialties were grouped by Medicare Data on Provider Practice and Specialty taxonomy classifications: primary care, medical specialty, surgical specialty, obstetrics/gynecology, hospital-based specialty, and psychiatry. [..] Payments were aggregated per physician annually, then categorized by cumulative aggregate value (≤$10,000; $10,001-$25,000; $25,001-$50,000; $50,001-$100,000; $100,001-$500,000; and >$500,000). Values were adjusted to the 2018 Consumer Price Index. [..] Of the 2014 cohort of … Read More
“In 2012, there were 35,700 hospital-owned physician practices, and in 2018, there were 80,000 hospital-owned physician practices, constituting 128 percent growth. The coronavirus pandemic may actually accelerate these acquisitions due to reduced revenues for independent physician practices. [..] For consolidated health systems that include hospitals and employed physician groups, health care executives face significant pressure on finding appropriate resource allocation to cover fixed and variable costs of inpatient care while also funding alternative sites of care. Striking this balance with a fixed budget is not obvious, and health care executives may need to divest from more expensive hospital-based labor and … Read More
“The expansion of the direct-to-consumer (DTC) medical imaging market elicits several safety and ethical concerns. Discounted DTC imaging may lead to unnecessary testing and subsequent incidental findings, false-positive results, radiation exposure, and downstream interventions. Groupon, Inc, a global e-commerce marketplace, has garnered media attention for its vouchers for discounted DTC medical imaging services. In this study, we evaluated the scope, pricing, customer feedback, and claims of medical imaging services offered through Groupon vouchers. We performed a cross-sectional analysis of Groupon offerings in the US on February 6, 2020. On the Groupon home page, in the Imaging and Scans section [..], … Read More
“On October 29, 2020, the Departments of Health and Human Services (HHS), Treasury, and Labor issued the “transparency in coverage” final rule. The rule imposes new transparency requirements on group health plans and health insurers in the individual and group markets. [..] plans and insurers must disclose cost-sharing estimates at the request of an enrollee and publicly release negotiated rates for in-network providers, historical out-of-network allowed amounts and billed charges, and drug pricing information. The rule’s goal is to enable enrollees to estimate their cost-sharing before receiving health care to encourage shopping and price competition amongst providers. HHS also amends … Read More
“[Oak Street, ChenMed, Partners in Primary Care (owned by Humana), Iora Health, Geisinger] contract with Medicare Advantage plans to provide primary care “on steroids” to older patients with multiple chronic illnesses, as one executive put it. Because they typically take full financial risk from the Advantage plans, which pay them fixed monthly fees for each patient, the clinics make money by keeping patients out of the hospital. They do that by providing preventive and behavioral health care along with managing chronic diseases and addressing social needs. Working with a team of clinicians and coordinators, doctors see about a fifth as … Read More
This week’s refresh of the excess mortality count from the CDC (last updated October 28 [I think]). The federal agency identified over 294,000 excess deaths across the country since the start of this year (about 5,000 more than last week’s estimate). The overall excess mortality rate decreased from 11.4% last week to 11.3% this week. Data from CDC’s National Center for Health Statistics, updated October 28, 2020
“In recent years, a worldwide increase in the incidence of thyroid cancer has been acknowledged and has primarily been attributed to overdiagnosis of small, low-risk papillary thyroid cancers. Observational evidence suggests that active surveillance is a safe and effective management option for carefully selected patients with low-risk papillary thyroid cancers. In light of this contemporary data, guidelines now include more conservative treatment options for patients diagnosed with papillary thyroid cancer. Ultimately, these guidelines help to avoid potential overtreatment and improve quality-of-life outcomes. Yet despite all this, the willingness to accept less invasive management options, specifically the uptake and acceptability of … Read More
“Concerns about hotspots flaring in schools of all types, sports teams, and workplaces lend special urgency to answering how best to limit the spread of COVID-19, and specifically how to test for and track the SARS-CoV-2 virus in the general population. An ongoing public health debate centers on whether we should use sub-optimal tests on a massive scale, testing frequently to overcome their analytical shortcomings. The basic argument was encapsulated in the 9/11 Health Affairs post by Paltiel and Walensky and has two parts. First, that widespread screening will dramatically expand testing capacity and ease ongoing strain on critical supply … Read More
“Surgeons were recruited from the Illinois Surgical Quality Improvement Collaborative in 2016 for a video-based technical skills assessment program.4 Each surgeon submitted 1 representative video of a laparoscopic right hemicolectomy that they performed. Videos were reviewed by 12 or more surgeons, including 2 colorectal surgeons with video evaluation experience. Skill scores were assigned using the American Society of Colon & Rectal Surgeons Video Assessment Tool, and the mean score from all raters was used. Skill score was analyzed separately by terciles and as a continuous variable. Patients who underwent any minimally invasive colectomy for stage I to III epithelial-origin colon … Read More