All posts by mdmunk

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 ...

How Big is too Big? On “Diseconomies” in Large Healthcare

With healthcare mergers now announced seemingly every week, I’ve been giving some thought to scale:  How big can/ should health systems be?   Anecdotally, I’m struck that the most impressive healthcare companies in America are super- regional players:  Geissinger, Cleveland Clinic, UPMC, etc.  They seem to get a lot more attention than the national players with hundreds of facilities. ...

To Reduce Physician Burnout Eliminate Garbage Time

Here’s a new chart from the AMA (reprinted from work done by Dr. Shanafelt and colleagues in Mayo proceedings) that reports the percentage of burnt out physicians sorted by specialty.  It’s a pretty horrifying report.   I’m not at all surprised to see emergency medicine at the top of the list. There are a bunch of theories on the ...