Financial Management

The Last Days: Cash or Credit?

How often do you hear the following: the average senior utilizes  25% of their lifetime health spend during their last six months of life.  Too much. All that service use in such a concentrated period suggests possibilities. ICUs and inpatient care have great costs.  Our acute and post-acute institutions also do not hold up as models of efficient care delivery.  Most of them at least. What to do? I see the above observations as something akin to an emperor with no clothes. Because leaders with checkbooks have a focus on areas that will generate cost reductions, they seek opportunities they can wrap their arms around.  The more disadvantaged and disjointed ambulatory practices cause too many headaches.  Hospitals then seem like the right place.  Hospitalists and inpatient practitioners seem like the right people. The logic goes, with advanced directives and creative thinking, the right docs and facilities can make a dent…

Wine Lists, StubHub and Healthcare: Who’s Getting Value Right?

By now, you’ve probably heard the news: providing a price transparency tool to patients does not seem to lower healthcare prices. In fact, according to this very large JAMA study, patients who were offered access to a price transparency tool seemed to spend slightly MORE compared to those patients without access. So, I guess put that whole price transparency idea to bed. Well, perhaps not so fast. As Dr. Kevin Volpp thoughtfully points out in his accompanying editorial, this study shows that price transparency tools will not be a “panacea” by themselves (who actually thought they were going to be in the first place?), but that there are many important considerations for interpreting the results of this study. I think by far the most important caveat is that the tool only included cost information, without any real context. Think about this for a second. When looking at a long wine…

You’ll Receive High-Value Care…Or Your Money back?

As hospitals across the country increasingly focus on patient experience, one health system, as we’ve written about before here on The Hospital Leader, is really putting their money where their mouth is: they are offering patients direct refunds, no questions asked. An article in The Washington Post calls these refunds, “the most unexpected hospital billing development ever.” The article opens with, “At Geisinger Health System in Pennsylvania, hospital officials want to keep their customers happy.” Ok, I hear some of you already sharpening your pitchforks. You take care of PATIENTS, not CUSTOMERS. Agreed, but there is something that both of these titles have in common: underneath them are people. Real-life people, who care about how they are treated on a personal level and yes, they want the best possible medical care but they also would like their meal to be edible and their physicians to speak to them with respect,…

Here’s Why This Is The Best Study On Readmissions To Date

  Love or hate readmission rates as an effective measure of institutional performance, the benchmark has become the coin of the realm for QI gurus, policy geeks, and stat crunchers.  As such, we see new journal releases every week--mostly data dives into large registries where the conclusions proffered are tentative at best.  Clinicians rarely get studies comprised of patient-level information whose findings may impact how to better organize their PI interventions and direct care.  That just changed (see excerpted table at bottom). Andrew Auerbach, MD MPH and colleagues just published, Preventability and Causes of Readmissions in a National Cohort of General Medicine Patients in JAMA IM, and the results merit a deeper look.  Andy was kind enough to answer some questions regarding his group's important paper for the blog. Q:  Andy, first off, you and your collaborators should be congratulated on releasing the most exhaustive study on readmission root causes to date. For readers, can…

Single Payer Healthcare in the US? What?

by Dr. Douglas Mitchell MD, MBA
by Dr. Douglas Mitchell MD, MBA  On January 10, 2014 the state of Maryland announced a new approach to hospital payments that would radically alter how healthcare is delivered in the state. Hospitals would no longer be incentivized to generate more volume but would instead be rewarded for keeping people out the hospital. Uwe Reinhardt, a health care economist at Princeton University said "This is without any question the boldest proposal in the United States in the last half century to grab the problem of cost growth by the horns." Understanding healthcare reform efforts in Maryland requires a little bit of wonkiness but components of the Maryland plan will likely become part of national healthcare reform efforts. Like all change there are opportunities for people to excel in the new system, and in order to excel hospitalists need to adapt intelligently to the new environment. A Little History for Context:…
Dr. Douglas Mitchell MD, MBA is CEO and a founding partner of Physicians Inpatient Care Specialists (MDICS). He began working as a hospitalist in 1998 at Anne Arundel Medical Center in Annapolis, Maryland. While at AAMC he became the lead hospitalist and grew the program from four FTEs to over twenty FTEs, started a surgical hospitalist program, and became president of the medical staff. In 2007 he started at private hospitalist group at Anne Arundel Medical Center – Physicians Inpatient Care Specialists or MDICS. Since 2007 MDICS has grown to over 300 providers contracted to provide hospitalist services in sixteen hospitals and to provide geriatric services in over 45 skilled nursing facilities. He spends free time gardening, growing berries, and keeping bees. He also enjoys puttering around the house and trying not to hurt himself with power tools.
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