Latest Blog Posts & Articles

Think Generics Will Lower the Cost of Chemo? Think Again

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Chemotherapy drugs have become ridiculously expensive. Many new drugs come to market costing more than $100,000 per patient for a full course of treatment. Often, patients have to pay a significant portion of these costs. For example, a 20% co-insurance rate, typical for basic Medicare coverage, leaves patients responsible for more than $20,000 of chemotherapy costs, an often crippling burden.

Fortunately, many expensive cancer drugs are going off patent soon, raising hopes that generic alternatives will significantly lower patients’ expenses.

Time to dash those hopes. Or at least generate some caution about just how much generic medications will lower chemo prices. The source of my hope dashing is a study done by Ashley Cole, a PhD student at UNC (a school that has dashed would the hopes of people like me, at Duke, more than a few times).

Posted in Critical Decisions

Physician Burnout — These Characters Are To Blame

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Physician burnout in the U.S. is reaching epidemic levels, affecting the majority of physicians in some specialties. Practicing medicine is, of course, a stressful job. Make a mistake and you might end someone’s life. But physicians are not usually burned out by such life and death matters. Instead, it’s the most mundane part of their jobs that’s driving them away from the profession.

They’re getting burned out one keystroke at a time.

(To read the rest of the article, please visit Forbes.)

Posted in Behavioral Economics and Public Policy

Hospital Price Transparency

The US is finally making very small strides towards pulling healthcare prices out of the shadows. Here is a recent media story on the topic.

U.S. hospitals are now required to list the prices of medical services online and update them annually, under a rule change that went into effect Jan. 1.

Previously, hospitals only needed to provide standard pricing to people and to make it available upon request.

To read the rest of this piece, please visit the The Epoch Times.

Posted in Behavioral Economics and Public Policy

When Farmer Joe Gets Sick, Here’s Who He Sees

In this March 22, 2010 photo, Amanda Cockrell, 32, left, a nurse practitioner at Rush Lifetime Medical Associates examines Shanequa Reeves, 18, in Chicago. With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor’s watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called “Doctor.” (AP/John Smierciak) photocredit: ASSOCIATED PRESS

The U.S. isn’t exactly overflowing with primary care physicians. The job pays poorly compared to most medical specialties, while often requiring mastery of a fraud range of material. In fact, with expansion of insurance coverage through the Affordable Care Act, many experts worried that it would become increasingly difficult for people to gain access to primary care physicians, especially in rural parts of the country, which have long-standing shortages of such professionals.

So when Farmer Joe gets sick, who does he see? With increasing likelihood, he’s being cared for by a nurse practitioner (NP).

(To read the rest of the article, please visit Forbes.)

Posted in Health Policy | Tagged

How Hospitals Turn Charity Care Into Profits — At Taxpayers’ Expense

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Sometimes it is hard for hospitals to provide expensive care to poor patients. When a low-income patient needs $20,000 of chemotherapy, a hospital loses money if that patient cannot pay for the medicine, or pays through Medicaid, with its relatively stingy reimbursement. Fortunately, the federal government created a program for hospitals that care for a disproportionate share of low-income patients, whereby they can purchase those medicines at a discount. The program is called the 340B Drug Pricing Program and, unfortunately, hospitals are taking advantage of the program, leaving taxpayers on the hook.

Here’s how the program works. Under 340B, if more than 11.75% of a hospital’s patients are low-income, the hospital can purchase the medicines at a steep discount. When, subsequently, the hospital doesn’t get paid for the medications – say, in the case of an uninsured patient with acute leukemia – the discounts reduce the hospitals losses. In other cases, when the hospital cares for Medicaid recipients (a program that often doesn’t cover hospital costs adequately), the discounts once again reduce their losses.

Here’s how the program fails. When the hospital treats a Medicare enrollee, it will typically receive a payment that is significantly greater than its costs. In those circumstances, the hospital will have bought the medicine at a discount while selling it at full price.

(To read the rest of this article, please visit Forbes.)

Posted in Uncategorized

Christmas Shopping Tip — Your Brain Knows What You Like Better Than You Do

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A song comes through your earbuds: good rhythm, clever lyrics, pleasing melody. You know whether you like the song, right?

Maybe not. A series of studies using brain imaging raise the possibility that sometimes we think we like or dislike things, but our brains know better.

I will explain what I mean, by describing one of the studies. In it, teenagers listened to songs while researchers measured their brain activity using fMRI machines. Basically, an fMRI shows how much blood is flowing to various regions of the brain over time; when a pleasurable song pipes into kids’ ears, for example, the pleasure centers of their brains light up. After playing music and scanning people’s brains, the researchers and participants went their own separate ways. Two years later, the researchers looked at how the songs they played for the teenagers that day faired in the ensuing time. Surprisingly, the teenagers’ readings of the songs – of how much they liked or disliked – did not predict subsequent downloads their expressed opinions about the songs were like faulty political polls, failing to predict how they actually felt about the music.

(To read the rest of the article, please visit Forbes.)

Posted in Behavioral Economics and Public Policy

The Insurance Companies That Are Most Likely To Refuse To Pay Doctors

Grunge red denied wording round rubber seal stamp on white background photocredit: Getty

Healthcare reimbursement in the U.S. is frighteningly complex. We have federal payers, like Medicare; state/federal payers, like Medicaid; private, for-profit insurance companies, like Aetna; private, not for profit insurers, like many local Blue Cross Blue Shield networks. Oh yes, and we have private insurance companies managing reimbursement for many Medicare and Medicaid recipients.

This complexity comes with costs. Doctors and hospitals need to hire armies of people to process bills for all those different payers. By one estimate, in fact, physician offices spend 30 billion dollars a year on billing-related costs.

A recent study shows which payers are most likely to reject the bills submitted to them by physicians’ offices. The winner, in case you haven’t guessed it already, is Medicaid, regardless of whether the program is run by the government or private insurers.

(To read the rest of this article, please visit Forbes.)

Posted in Behavioral Economics and Public Policy, Health Policy

Why Telling Your Children They Are Smart Could Turn Them Into Cheaters

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I am not one of those parents who believes kids should win trophies just for showing up for their t-ball games. But I’m also not stingy in praising my children when they do well. When my kids got hundreds on their grade school spelling tests, I told them how proud I was of their accomplishment.

But could praise like this turn our children into cheaters?

I’m thinking specifically about praise for ability rather than for effort. When children do well and we tell them how smart they are, are we making them feel pressure to cut corners to hold on to their “smart” identity?

(To read the rest of the article, please visit Forbes.)

Posted in Behavioral Economics and Public Policy

What Socialized Medicine Would Mean for Your Health

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Americans are not fans of socialized medicine. Sure, some people want socialized healthcare payment, including many people who are fans of Medicare for All. But even most Bernie Sanders supporters probably aren’t in favor of socializing the entire U.S. healthcare system, thereby making hospitals and medical clinics into government property. Americans are proud of the high quality of care offered by non-government providers, from their local community hospitals to places like the Mayo Clinic. Many are afraid that if doctors and nurses become government employees, the quality of their care would erode.

But a recent study of patients with kidney failure highlights the possibility that, at least for some people, socialized medical care is higher quality than private care.

The study looked at military veterans whose kidneys were failing, so much so that they might soon need dialysis. The research team, out of Stanford University, looked at how these veterans fared based on whether they received care in the VA system or at private clinics and hospitals.

(To read the rest of the article, please visit Forbes.)

Posted in Behavioral Economics and Public Policy, Health Policy

Why You Might Get Kidney Cancer If You Move To Florida

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About one in fifty people reading this essay will be diagnosed with kidney cancer at some time in their life. In fact, one out of one people writing this essay has already been diagnosed with kidney cancer. (I had a small tumor removed from my left kidney not long after I turned 50.) But how many people diagnosed with kidney cancer have been overdiagnosed with the condition? And what does moving to Florida have to do with your chance of being diagnosed with kidney cancer?

Let’s start with some facts about kidney cancer. The number of people being diagnosed with kidney cancer is rising dramatically in the United States. Just between 2001 and 2010, the rate of such diagnoses grew almost 20%. Some of that increase is due to the aging of the American population, and some to the increased rate of obesity. But much of it results from the increasing number of people receiving CT scans in the United States, for one reason or another, with those scans revealing suspicious growth in their kidneys.

(To read the rest of the article, please visit Forbes).

Posted in Critical Decisions, Health Policy, Uncategorized