All posts by mdmunk

Specialists and Practice Guidelines: On the Cash Cow in the Room

Here’s a personal story about medical overuse and willful ignorance. Stay tuned for the punchline. First, a little background: a couple of weeks ago I came across a great study on medical overuse, specifically adherence to national recommendations published in 2012 regarding the use of the PSA (prostate specific antigen) blood test to screen for prostate cancer.

On the “Bay State Boondoggle”

The Boston Globe recently ran an article discussing layoffs at Baystate Health, a large health system in Western Massachusetts.  The system is planing to lay off 300 employees to try to close a $75M deficit.  According to the Globe, the deficits are mainly driven by declining Medicaid reimbursement, but, more interestingly, by a $23M hit to Medicare revenue ...

Blended FFS and Capitation: Healthcare’s “Protective Collar” Paradox

Over a couple of posts I’ve discussed how difficult risk contracts can be for healthcare systems transitioning from fee-for-service. There are three main problems for systems trying to blend FFS and capitation-payment systems.  Two have been the subjects of earlier posts: Systems growing risk capability need to make big investments in population health and have to tolerate ...

Healthcare’s “Modern Movement”

For most of my childhood our next door neighbor, Nick, ran a niche sports magazine from his home.  Trained as an architect at the University of Toronto, Nick went on to work (for only a couple of miserable years) as an municipal architect with the city before dedicating himself full-time to sports. One of Nick’s most memorable ...

Segmenting Healthcare: What’s Your Customer’s Currency?

Over the past few years, I’ve spent a lot of time speculating about the emergence of consumer segmentation in the US healthcare market. As background, here are the three main conclusions drawn from previous posts:

Hospitals are Pigging Out on Commercial Reimbursement and Starving on Medicare. What’s Next?

The Spring 2016 Medpac report on Medicare payments is out.  This annual report to Congress (put together by the 17 members of the Medicare Payments Advisory Committee) provides an assessment of the way Medicare pays for care, and offers recommendations for how to modify payments going forward. It’s a fascinating snapshot:

On Healthcare as a Complex System: Ensuring Context and The Capacity to Adapt

There is a minor brouhaha in the world of healthcare quality and process improvement.  It started with a perspective piece written by Pamela Hartzband and Jerome Groopman published in a January issue of the New England Journal.  In the essay, (and I’m paraphrasing) Groopman and Hartzband argue that process improvement tools like LEAN are “medical Taylorism” that lead to ...