Latest Blog Posts & Articles

What Healthy Cereal Boxes Should Look Like

A while back, former FDA Commissioner David Kessler published an article in the New England Journal depicting what cereal boxes would look like if they provided people with useful health information. Here is a sample:

What Healthy Cereal Boxes Look LikeWhat do you think?

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The Connection Between Great Science and Great Writing

Photo Credit: National Geographic

Photo Credit: National Geographic

Often great science depends on keen observation. Darwin built his theory of evolution on detailed observations of everything from birds to beetles. Jane Goodall revolutionized our understanding of primate behavior by staring at chimpanzees for hours and days. But not just staring at them, noticing them. She saw things most observers would not have picked up.

That keen observational ability shows up in her writing. Riding in a boat destined for Africa prior to the birth of her scientific career, she wrote about her view of the sea. It is a strong bit of writing, especially from someone only 22-years-old:

“The sea is dark inky blue, then it rises up a clear transparent blue green, and then it breaks in white and sky blue foam. But best of all, some of this foam is forced back under the wave from which it broke, and this spreads out under the surface like the  palest blue milk, all soft and hazy at the edge.”

The humanities and sciences are not always far apart from each other. That’s another reason to push for our best universities to encourage, maybe even require, science students to immerse themselves in other disciplines.

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Watch Out Hospitals: Medicare’s Planning to Punish You if You Misbehave

It used to be that hospitals billed Medicare for the services they provided, and Medicare – I know this is crazy! – simply paid the bills.

Those days are rapidly receding into history. Soon, a significant chunk of hospital revenue will be at risk, under a series of Medicare pay-for-performance programs. The idea behind P4P (as the cool kids call it) is simple. Third party payers, like insurance companies or the Medicare program, will monitor the quality of care offered by health care providers like hospitals. High quality providers will receive more money than low quality ones, thereby giving providers an incentive to improve the quality of care they provide.

Medicare has created several P4P programs which, unless they are halted by the Trump administration, are slowly coming into effect. By 2017, as I will show in a bit, these programs could put a sixth of Medicare payment at risk.

What are these programs?

One is the Hospital Value-Based Purchasing Program or (and you have to give Medicare folks kudos for their marketing prowess) VBP. Under VBP, Medicare monitors a bunch of quality measures, like the rate of hospital acquired infections, the number of patients falling while in the hospital, and even the risk adjusted mortality of hospitalized patients. Medicare scores each hospital based on how well it performs compared to other hospitals, and compared to its previous performance. This score determines part of a reward or punishment at the end of the year. By 2017, 2% of Medicare hospital payments will be redistributed according to VBP results, with money transferred from low to high performing hospitals.

Medicare has created another acronymically-challenged program, HRRP, which stands for Hospital Readmissions Reduction Program. The program measures how often patients with diagnoses like heart attacks, congestive heart failure, and pneumonia are readmitted to hospitals after an initial stay. The program will financially penalize hospitals that have excessive readmission rates.

Finally, under its HAC program (not named after the sound made by someone with bronchitis), Medicare is tracking how well hospitals reduce the rate of Hospital Acquired Conditions, like catheter-related bacterial infections. Some of these measures overlap with the VBP measures, amounting to a double counting. That’s a problem I’ll talk about in a minute.

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


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Holy Life Expectancy!

Look at this trend in life expectancy, U.S. vs other developed countries, as a function of healthcare spending:

Holy Life ExpectancyKeep in mind, I DO NOT think life expectancy is a good way to judge the quality of healthcare or the efficiency of healthcare spending. But the graph should make us think about what we need to do, outside of our healthcare system, to help Americans live longer and better lives.

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Is This Enough Competition for You?

Some people look at the figure below, and say that too few insurance companies have too much of the market for Medicare Advantage (a program that allows Medicare recipients to get private coverage). But I look at it and think it looks like a pretty robust market:

Is this enough competition for youWhat do you think?

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Another Obamacare Failure: It Wasn’t a Job Killer!

According to many conservative pundits, Obamacare is a job killer. Five days before Obama signed the law, in fact, speaker John Boehner declared that the president was pushing “his job killing government takeover of healthcare that will hurt small businesses.” Years after the law was passed, critics continued trumpeting this theme, Ted Cruz calling Obamacare “the biggest job-killer in this country,” and even claiming that “millions of Americans have lost their jobs” because of the law.

Are the critics right? Liberals point to steady national job growth since passage of the law as evidence that Obamacare has not killed jobs. Conservatives point out that, for all we know, job growth would have been even higher had Obamacare not become the law of the land. Both sides are caught in a rhetorical standoff, seemingly with no way to confirm or refute either side’s argument.

Fortunately, social science gives us ways to move beyond data-deficient arguments to something more substantial. In the case of Obamacare, a strange twist in the law has given social scientists an opportunity to study a natural experiment. That experiment relates to the expansion of Medicaid that was written into the law, an expansion that was supposed to be mandatory for all states. Medicaid is a program jointly run by the government and individual states to provide healthcare coverage to low income people. After Obamacare was passed into law, the Supreme Court ruled that this Medicaid expansion cannot be mandatory, and gave states the option of deciding whether or not to expand their programs. This variation in expansion is what allows policy analysts to study this natural experiment.

Here’s the basic idea: If Medicaid expansion kills jobs, then all else equal, states that expanded Medicaid should have worse job growth than those that did not. For instance, Medicaid could reduce people’s incentives to work, because they no longer need jobs to pay for healthcare coverage. Or it could kill jobs by increasing federal and state taxes, thus leaving Americans with less money to invest in the economy. To test out the effect of Medicaid expansion on employment rates, Angshuman Gooptu and colleagues compared employment rates before and after the Obamacare Medicaid expansions went into effect, and compared these before and after differences in states that did and did not expand Medicaid eligibility. This is what is known as a difference in difference analysis or, as the cool kids call it: “diff in diff.” In studying employment, the researchers focused on low income workers, the ones most likely to be affected by Medicaid expansion.

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

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Behavioral Science Of Eating – In One Picture!

The Journal of the Association for Consumer Research (yes, there is such a thing!) had an outstanding issue dedicated to eating behavior recently. Here is a picture from that issue worth sharing:

Behavioral Science Of Eating

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6 Tips for Determining if a Doc-in-the-Box Is Right for You

A friend of mine recently had a very sore throat. She knew how to manage her symptoms–lozenges, warm tea and the like. But she was worried she might have strep and would therefore need antibiotics. That should be a simple question to answer with a quick trip to the primary care clinic. Except that her primary care physician was booked, and if she wanted an unscheduled appointment with someone else in the clinic, she was told that she would probably wait a couple of hours.

So she went to a “doc-in-the-box,” which according to the Urban Dictionary is “any doctor at a walk-in clinic.” She paid a modest fee and in a short time received a throat swab. The swab didn’t detect any strep, so she was soon back at home, with a tea kettle brewing and no fear of serious illness.

Primary care clinicians have a new competitor. Minute clinics, retail health clinics and other convenient alternatives are rapidly arising in many parts of the country, meeting unmet demand for timely, affordable care for minor complaints. The biggest players in this field include companies like CVS. These minute-like clinics are a real growth industry.

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

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You Know Who Loves Obamacare? U.S. Hospitals

You Know Who Loves Obamacare U.S. HospitalsBecause of Obamacare, more Americans have healthcare insurance and therefore more people are able to pay for medical care when they receive it. As a result, there has been a $5.7 billion drop in uncompensated hospital care just in those states that, per Obamacare, expanded Medicaid eligibility:






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Post Op Narcotics

Recovering from surgery can be painful. That’s why lots of surgeons give patients narcotics post-operatively. But that is also the time when people can get hooked on narcs. Here is a picture of how many patients take narcotics for at least 3 months following a surgical procedure:

Post Op Narcotics

Perhaps orthopedic surgeons should ask for help from palliative care/pain specialists for more of their patients!

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