All posts by mdmunk

Once A Sail, Now an Anchor: Medicare Incentive Programs are Making Safety-Net Hospitals Unaffordable

Here is an interesting exercise and an unfortunate lesson in the law of unexpected consequences: Pop Quiz: Your elderly Granny comes from overseas without insurance and suddenly needs her gallbladder taken out.  You call around the hospitals in town and they agree to extend to you the same rates as they would charge Medicare.  (This is hypothetical, of ...

Transitioning to Risk- Getting Over the Straddle

This week I gave a presentation on “transitioning to risk” at a great meeting with a large group of seasoned healthcare executives in Nebraska. One of the points I made was this:  it is important to remember that when transitioning to risk from fee-for-service, a healthcare organization has to expect a period of poor financial performance before the financial ...

On Getting Burned by Population Health Thinking: (Why has a Decade of Intervention not Prevented More Deaths From Brain Aneurysms?)

In our house we take a lot of fizzy vitamin C to prevent colds in the winter. As doctors, my wife and I both know that science doesn’t support our decision… We take it anyway. We shouldn’t. After all, the well respected Cochrane group (which grades and distills multiple studies into a single “meta-analysis”) clearly ...

More Thoughts on Segmenting Healthcare: Who’ll Serve the “High End” of the Market?

In a few previous blog posts I’ve written about market segmentation in US healthcare.  I’ve made the observation that healthcare delivery companies which once targeted geographies (we are a nation of “XYZ Regional Hospitals” after all) now target demographies.  Witness, for example, Walmart’s bold move into $40 primary care visits ( with a goal of being America’s largest provider of primary care“) and ...

Can “Agile Teams” Reform Healthcare Systems?

I recently had lunch with an experienced physician executive from a large academic medical center.  He told me that his organization was trying to migrate from fee-for-service to risk, and that management had appointed a bunch of large committees to oversee everything from a new cost accounting system to the development of multiple external partnerships.  

A (Lower Cost) Healthcare Industry to Deal With a (Higher Cost) Healthcare Industry

I was recently on the phone with a medical device company executive who was describing his company’s efforts to develop a non-invasive diagnostic device that could quantify the degree of cirrhosis in a patient with liver illness.  It’s technology that his firm sees as timely given the recent introduction of Solavdi and other Hepatitis C therapies: the device will be offered as a way ...

The Pendulum Swings Between Individualism vs. Collectivism in US Healthcare. What Does the Next Decade Hold?

Communities don’t think, don’t believe, don’t want, don’t have needs, don’t have interests and don’t make decisions. Only individuals have minds that generate desires and needs – and only individuals can make choices and decisions. Harry Browne- Libertarian Candidate for American President, 1996 and 2000 When I visit my European in-laws, some who work in ...