All posts by mdmunk

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 ...

On Feedback Loops and the Selective Amplification of Random Healthcare Data

Here, within six minutes of one another, are two tweets on the subject of Amazon’s fourth quarter results, one from CNN and one from the WSJ:

Consolidating Surgery: Another Example of Balancing Population-Level Improvements with Poignant Individual Loss

In healthcare quality circles it’s become a truism that high surgical volume is linked to improved outcomes.  If you want to have the best surgical result, the thought goes, find the surgeon who has done the most cases like yours… Harvard’s Ashish Jha outlines the case in a recent JAMA Forum: We have always known that volume ...

Healthcare’s Friendly Societies: What Would a Healthcare Mutual Look Like?

For a few years I’ve been fantasizing about what a healthcare insurance/ delivery mutual would look like.  I’ve yet to see one but I like the idea a lot. Here’s the idea behind a mutual:  A mutual structure means that the company is owned by its clients or policyholders.  Since a mutual’s customers are also its owners, ...

Swiss Flight 188, the Normalization of Deviance and a Better Way to Communicate: Lessons for Healthcare Leaders

I recently came across some captivating footage of a Swiss Airlines flight crew dealing with the unexpected loss of an engine.  Watch this- you won’t be able to take your eyes off this smooth, competent crew.  

Express Scripts Undoes Turing Pharmaceuticals: Witness the Rise of the “Activist” PBM

Everyone knows the recent story of “rapscallion” Martin Shkreli: the ethically depleted CEO of Turing Pharmaceuticals who bought the rights to Daraprim, a generic anti-parasitic medicine and marked up the price of a tablet from $13.50 to $750 overnight.   As disgusting as Shkreli’s story is–  the more important and interesting tale is how Turing was subsequently undone by ...