Category: Healthcare Costs

The New-Economy has Created a Trade Deficit in Small Cities and Towns. Healthcare Spending is the Bulwark

I recently drove through Lewiston, Maine.  It’s no longer the flourishing city it once was, though until the early 20th century Lewiston (seen in the drawing above) was a booming American mill town.  Its factories, hydro-powered by the Androscoggin River, were linked by rail to Boston and other large cities.  Like many mill towns in New England, ...

On the Tragedy of the Commons: the Toxic Effects of Drug Co-Pay Coupons

Last week I was driving through Phoenix when I saw this sign at an intersection: It struck me that this was a perfect example of what happens when clever business folks figure out a way to short circuit the normal laws of consumer behavior.    How’s it work?  Bring your car in and the glass shop bills ...

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 ...

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:

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 ...

Administrative Bloat in Healthcare is a Land of Opportunity: On Direct to Consumer Price Transparency

I was recently connect with two smart entrepreneurs (James Millaway and Stan Schwartz, MD) who run a company called The Zero Card.  Their business is a platform where consumers and employers have access to transparent “cash” prices for a range of medical services.  Providers display their best non-insurance rates and offer a fixed price for an episode of care. Individuals (or ideally self-insured ...