“Despite the convenience and value of telehealth, many states have rolled back COVID-19 pandemic–era flexibilities and reimposed strict licensure requirements for telemedicine. Thus, as it was prepandemic, so it is again that a physician, duly licensed in their home state, is prohibited from consulting or following up with an out-of-state patient via video or phone unless they are also licensed in the patient’s state. Penalties for doing so without that license can amount to tens of thousands of dollars in fines and potential imprisonment. Despite growing pressure to respond to patient preferences and widespread evidence of the benefits of interstate … Read More
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“An estimated 80% of physicians are now employed by hospitals, health systems, and corporations. Many factors have contributed to this shift away from independent practices, including rising administrative burdens, changing employment preferences, greater capital demands for health information technology, and favorable financial incentives (eg, site-differential payments). However, underappreciated among these factors is another important accelerant of corporate consolidation: the shift from fee-for-service to value-based payment models. [..] Evidence suggests that, on average, they [independent practices directly owned by clinicians] exhibit lower per-patient spending, fewer preventable admissions, and lower readmissions compared with their hospital-owned counterparts. [..] However, independent practices are often … Read More
“The basic benefits package of Medicare — replete with deductibles and coinsurance — long ago began falling short of the promise of financial protection as articulated by President Lyndon Johnson in 1965. In 2019, out-of-pocket spending in traditional Medicare averaged $7,053 among all seniors and $12,315 in the top decile, which was equal to 25% of seniors’ mean after-tax income and to 69% of retirees’ mean Social Security income. [..] Over time, Medicare Advantage has evolved into a conduit for financing coverage expansion that is arguably overdue. Enrollees enjoy substantially lower premiums for supplemental and prescription drug coverage than they … Read More
“Why would more screening in both Black and white Americans reduce the mortality disparity between the two groups? What’s more, cancer screening actually stands out for its lack of racial disparity. The proportion of Black and white women having mammograms has been virtually identical for the past three decades (in fact, Black women currently have the test at slightly higher rates). Yet deaths from breast cancer are about one-third higher in Black women. For the past two decades, a similar pattern has been seen in colorectal cancer screening — equal rates among Black and white Americans — yet colorectal cancer … Read More
“Landeiro and colleagues computed the economic burden of four diseases (cancer, coronary heart disease [CHD], dementia, and stroke) in England using consistent methodology and a broad definition of disease burden. This analysis is an important advance that will allow policy makers, researchers, and other stakeholders to assess the absolute and relative burden of these diseases in a meaningful way. The Global Burden of Disease also uses a consistent methodology for estimating the burden of many diseases across countries. However, its methodology focuses only on mortality and morbidity, which are evaluated comprehensively, but does not account for many other costs included … Read More
“As artificial intelligence (AI) tools become more consistently used in health care, federal agencies, health care facilities, medical societies, and other stakeholders are grappling with how to ensure they do not introduce unintended patient harm. [..] Regardless of approach, a well-designed one could improve safety, promote patient and health care professional confidence in AI use, and incentivize developers and users to focus on these important issues. Developing a testing and certification approach that is effective, rigorous, and rapid and that is a shared responsibility of both developers and users is necessary to meet the needs of multiple stakeholders. The Office … Read More
“Colonoscopy is the dominant approach to colorectal cancer screening in the United States. Among people who are screened, two thirds get a colonoscopy. This fact is easy to miss in Halpern and colleagues’ 2021 data, which included 9.2 million people reporting colonoscopy and 9.8 million reporting fecal immunochemical testing (FIT). That ambiguity is explained by the distinct screening intervals (every 10 years for colonoscopy and annually for FIT), whereas there is no ambiguity about the difference in the resources required each year: $24 billion for colonoscopy versus $0.6 billion for FIT. Colonoscopy is clearly overused in the United States. It … Read More
“Although this new frontier of [vertical] consolidation has the potential to generate efficiencies [UnitedHealthcare’s ownership of Optum Health (providers), Change Healthcare (analytics), a pharmacy benefits manager, pharmacies and a bank], there are also risks: vertically integrated conglomerates can deploy a range of financial tactics and engage in market abuses that raise costs, undermine fair competition, and erode the quality of patient care and physician morale. Driving this vertical consolidation has been the tidal shift from fee for service toward “capitation based” financing in public programs. Under these financing models, the federal government and state governments delegate the management of a … Read More
“In January 2024, the pharmaceutical company Eli Lilly launched LillyDirect, a service that includes a direct-to-consumer pharmacy and a referral network of in-person and telehealth clinicians. These tools are intended to add new options for patients to access the company’s drugs, including its newly approved antiobesity drug tirzepatide (Zepbound). [..] LillyDirect is similar to several pharmacies that cut out insurers and PBMs [pharmacy benefit managers] and allow patients to purchase drugs at discounted cash prices. These include pharmacies introduced by major retail companies like Walmart, Costco, and Amazon, and independent pharmacies like the one named for its billionaire cofounder Mark … Read More
“Over the years, medical schools have made some progress in diversifying their student bodies, with numbers ticking up. But just like undergraduate admissions, wealth and connections continue to play a determining role in who is accepted. More than half of medical students come from families in the top 20 percent of income, while only 4 percent come from those in the bottom 20 percent, according to data from the Association of American Medical Colleges. There is also a family dynamic. Children of doctors are 24 times more likely to become doctors than their peers, according to the American Medical Association. … Read More