This month, CMS published its proposed 2019 physician fee schedule. The document is 1,472 pages long and is so it is not a quick read. There are a LOT of changes but the most notable is a dramatic way that Medicare will change reimbursement for outpatient evaluation and management (E/M) services. The proposed E/M reimbursement […]
What Medicaid Expansion Tells Us About America’s Health
Medicaid expansion has been a rallying cry for both the politically far left and the politically far right. This post will examine some of the healthcare differences between those states that participated in Medicaid expansion and those states that did not expand Medicare. At its most simplistic, Medicaid expansion has increased federal and state government costs […]
Gaming Hospital Metrics
Hospital and physician performance is measured by a lot of different quality metrics and everyone wants to look good. Sometimes, there are ways to make yourself look good without actually being good – by gaming the metrics. Nobody actually talks about these gaming strategies but a lot of people think about them. I’m not recommending […]
The 2017 Medicare Hospital Star Ratings: Better But Still Not Perfect
Two years ago, I wrote a (rather scathing) post about the 2016 Medicare star rating system for hospitals. Last January, I posted an update about the 2017 star ratings. The 2017 star ratings were supposed to be published last summer but Medicare delayed the release in order to revise the methodology and address some of the criticisms […]
The High Cost Of Observation Status
Medicare and commercial insurance companies love observation status. When a patient has to be hospitalized but only for “less than 2 midnights hospital stay”, then that patient is classified as being in observation status rather than admitted to the hospital. This classification means that the patient is technically an outpatient and not an inpatient and […]
Age Of Physicians By Specialty
At this month’s American Thoracic Society meeting, it was reported that 1/3 of practicing pediatric pulmonologists in the United States are over age 60, a scary number since that indicates we are soon facing shortages of pediatric pulmonologists. It turns out that it is not the only specialty with disproportionately older physicians and these statistics […]
How Many Days Cash On Hand Should A Hospital Have?
When a hospital runs a positive margin and makes money at the end of the year, everyone wants some of it – hire more doctors, hire more nurses, buy a new MRI machine, build a new hospital wing. It can be tempting to spend it all but should you? Liquidity is survival insurance for a […]
The 5 Faces Of Value In Medicine
In medicine, we talk about quality a lot. But most of the time that we are talking about it, we’re really not talking about quality at all. You see, quality means different things to different people and most of the time, we are confusing quality with value. Value = Quality ÷ Cost There are 5 […]
Why U.S. Health Care Is So Expensive
This month, an article in JAMA gives us some ideas of why American medical costs are so high. The authors analyzed data from the OECD (Organisation for Economic Co-operation and Development). The OECD maintains a huge database of economic information from most of the world’s developed countries. Their healthcare database is particularly useful to anyone […]
The High Cost Of Physician Billing
When I open a newspaper, I expect to get depressed about the bad news that fills the paper. But when I open a medical journal, I don’t expect to get depressed, I expect to get enlightened about new methods, awed at new technological advances, and inspired by human stories… today, though, I just got more […]