Supply of Medical Services

Quality of Care at Teaching Hospitals

Medicare pays higher reimbursement to teaching hospitals through indirect medical education (IME) payments to hospitals that train a high share of residents. IME inflate standard reimbursements in an attempt to compensate hospitals for these additional costs. Medicare also pay hospitals directly for some cost of training residents through the graduate medical education (GME). A key …

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Nursing shortages

While the COVID-19 pandemic continues, the worst part of the pandemic is largely past us (see NYT graph) with more people getting vaccinated. One would expect that as vaccine uptake has risen and cases have fallen, interest in the nursing profession would rise and those who left the nursing profession due to COVID-19 may return. …

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CMMI and its revised strategy

Created by Section 3021 of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Innovation (CMMI; aka The CMS Innovation Center) has been tasked with creating new reimbursement strategies to improve quality and decrease costs. Over the past decade, CMMI has tested over 50 new payment models, and in just the last 3 …

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Food insecurity among health care workers

When you think of health care workers, many think of physicians, nurses and hospital administrators, who often make an above average salary. Not all health care workers, however, are well-paid and many even suffer from food insecurity according to a study by Srinivasan et al. (2021): Using nationally representative data from the period 2013–18, this …

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Physician Switching After Drug Request Refusal

That is the title from a study from Lee and Bagley (2011). They examine the potential impact of direct to consumer advertising (DTCA) and the impact of physicians decisions not to prescribe a patient-preferred drug on patient retention. A total of 818 of 2,988 participants in a national telephone survey (27.4%) who had received DTCA …

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Impact of Certificate of Need on Health

An interesting paper from Kevin Chiu in the Journal of Health Economics looks at the relationship between certificate of need laws and health outcomes: Certificate of need (CON) regulations requires that health care providers obtain state approval before offering a new service or expanding existing facilities. The purported goal of CON regulations is to reduce …

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Integrated Delivery Network-based Specialty Pharmacies

Increasingly, integrated delivery networks (IDNs) are creating their own full-blown specialty pharmacies. Many are familiar with the integrated payer-provider model from groups such as Kaiser Permanente. However, other IDNs are getting into the game according to a recent white paper. Why are IDNs considering creating their own specialty pharmacies? Address patient access concerns. The number …

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‘Big is beautiful’ when it comes to physician practices?

A book by Robert Atkinson and Michael Lind argued that big businesses–rather than small businesses–are the drivers of the economy. That book had the catchy title “Big is Beautiful“. A related question in the area of health economics is whether larger physician practices do better than smaller physician practices. Perhaps large practices can benefit from …

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Health systems bringing specialty pharmacy in-house

That is one trend as reported in Modern Healthcare. Being able to better managed health care spend across medical and pharmacy is one reason. In 2018 alone, about 76% of hospitals with over 600 beds operated a specialty pharmacy, in comparison to a little under half in 2016, according to American Society of Hospital Pharmacists. Growth in …

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How are ACOs trying to lower cost?

Accountable Care Organizations (ACOs) aim to use coordinated care to increase quality and lower cost. While everyone likes the sound of integrated care, it may be less clear how ACOs are aiming to achieve these goals. In a recent Health Affairs blog post, Micklos and co-authors review one study found that: …Next Gen ACO participants …

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Does the arrival of urgent care centers reduce the acuity of visits at nearby EDs?

Urgent care centers are on the rise. Back in 2013, there were only 6,100, but this number increased to 9,616 by late 2019 a 7.9% average annual increase. The rise of urgent care could have positive or negative impacts on overall health care spending. On the one hand, increased supply could lead to higher cost …

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The rise of the health systems

Health systems have been touted by some to be a cure to many of our health care systems ills by providing integrated, high quality care. Others claim that health systems are just a way for providers to big up prices through more bargaining power. Either way, it is not entirely clear to what extent health …

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A Haven No More

Haven was a high-profile effort whereby three industry titans–Amazon, Berkshire Hathaway and JP Morgan–created a joint venture with the hope of lower costs and improving quality. Today, Haven announced it is shutting down in February. What happened? I don’t know the answer, but below are a few possibilities. Scale. Although these are three large companies, …

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Private health care = higher quality

What is better: public or private health care systems? This is a difficult question to answer. If we compare the British against the US health care systems, they differ for a large number of reasons beyond just public vs. private. Additionally, one must specify what one means by public vs. private. Is this public vs. …

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Hospital CEO pay

How much are hospital CEOs getting paid? A paper by Mulligan et al. (2020) provides the answer: Between 2010 and 2015, mean hospital CEO compensation (in 2015 US$…) increased 7.8%, from approximately $639,000 to $689,000 (p = .05), and median compensation increased from $431,000 to $464,000. Not surprisingly, CEOs of larger hospitals systems get paid …

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On the promise and peril of health systems

Integrated delivery networks. IDNs. Accountable Care Organizations. ACOs. Systems of care. Health systems. Whatever you call them, many health policy experts claim that they are the best way for the U.S. health care system to deliver high quality care in a cost-effective manner. But is that really the case? A commentary by UCSD professor and …

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The Oncology Care Model is dead. Long Live the Oncology Care First Model.

The Oncology Care Model is slated to end soon. Specifically, the last set of six-month episodes would initiate no later than December 31, 2020 and thus all episodes will be completed in June 30, 2021. Nevertheless, CMS is proposing a successor to the Oncology Care Model called the Oncology Care First (OCF) Model. CMS describes …

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