On the morality of Insurance Premiums

As CVS-Aetna merger talks fill the air this Christmas season and experts weigh in on the impact this will have on the economy and consumers alike, I’m sitting at a little desk in a little office contemplating health insurance. I run a little shop that’s about as far from CVS-Aetna as you can get in…

Valuing Value based Payment

The idea that payment should be linked to the value lies at the heart of most of the transactions we participate in on a daily basis. Yet, value based payment in healthcare has seemingly run into very rocky waters as of late.  It is at this precarious time that stakeholders representing large employers and other…

The costs of public reporting

In an age where big data is king and doctors are urged to treat populations, the journey of one man still has much to tell us.  This is a tale of a man named Joe. Joseph Carrigan was a bear of a man – though his wife would say he was more teddy than bear….

So you want a CAT scan?

Who knew healthcare could be so complex?  On the eve of a healthcare vote, the two sides have sharpened their respective arguments.  The GOP proposal for health care reform rests on health savings accounts and high deductible health plans.   The basic premise is that price opacity, and deep pocketed third party payers drive up…

A tale of three brain tumors

There are 80,000 new cases of primary brain tumors diagnosed every year in the United States.  About 26,000 of these cases are of the malignant variety – and John McCain unfortunately joined their ranks last week.  In cancer, fate is defined by cell type, and the adage is of particular relevance here.  Cancer is akin to…

The case for the BCRA

Dr. Jha writes on these pages in typically stirring fashion about his views on the recent health care kerfuffle and rightly so fingers what the real focus of our efforts should be: Cost.  He ends by slaying both sides because of their refusal to confront the hospital chargemonster – the fee schedule hospitals make that…

Enrollment

Tweet storm Patient I saw recently 60 y/o woman found down in the parking lot Witnessess began CPR. EMS found VT on arrival, shock delivered Neurologic outcome thought to be moribund, but 10 days in to an ICU stay, pt awakes! She gets a cardiac cath (non obstructive CAD) ICD placed for secondary prevention She…

The Science of Medicaid

I remember 7 South at the Children’s hospital very well.   I remember the distinctive smell, the large rooms, the friendly nurses, and Shantel.   For a brief period of time, Shantel and her little boy – a too skinny child named James – were there every time I was there with my little girl….

The AHCA Fail: What winning feels like…

You may have heard that repealing and replacing Obamacare recently failed.  The analysis of what went wrong comes from many corners.  Andy Slavitt, former insurance executive and most recent director of CMS, writes that the ‘failure of Trumpcare can be seen as a rejection of policies that Americans judged would move the country backward.’  Apparently,…