Latest Blog Posts & Articles

More on Merger Mania

Photo credit:

Photo credit:

I recently wrote something in Forbes about all the mergers going on in the U.S. healthcare industry. Well here is a nice article about the growth of the healthcare system in Western North Carolina, that explores some of the same issues. Check it out:

Mission Health Partners, the Accountable Care Organization of Mission Health System, is adding 550 specialists to its network next year, according to a statement released Thursday morning.

The network, which Mission says is the second largest in North Carolina, has 275 primary care physicians.

Mission formed Mission Health Partners in June 2014. This group is different than Mission Medical Associates, which represents the company-employed doctors. It was created by private physicians, the hospital, company physicians and community health centers working in a group. Mountain Area Health Education Center also had input. Doctors who join the ACO get to tap into a system designed to share data on patients across the population.

They give up some independence in that they have to follow standards of care set by the ACO and share data on patients. But they could be financially rewarded for meeting goals.

“In general, expanded networks offer the possibility for better coordinated care,” said Dr. Peter A. Ubel, a physician and behavioral scientist who also is associate director of Duke University’s Fuqua School of Business Health Sector Management program.

“But that all depends on whether the network develops things like electronic medical records that enable its clinicians to easily communicate with each other,” said Ubel, who added that he didn’t know the Mission Health Partners network well.

Mission’s patients could see their health costs go up, he said.

“Larger networks also give health care providers more negotiating leverage with insurance companies, which could mean that prices will rise and, therefore, that insurance premiums might rise, too,” Ubel said. “But whether that happens depends in part on whether the insurance companies in the same area are also consolidating.”

To read the rest of this article, please visit the Citizen Times.

Posted in Uncategorized

Merger Mania in Medicine — What Will It Cost Us?

The federal government is currently debating whether the big six health insurance companies in the U.S. will soon become the big four. Aetna and Humana have announced plans to merge, as have Anthem and Cigna. The American Hospital Association and the American Medical Association strongly oppose the mergers, saying they will reduce competition in consumer markets.

Meanwhile, healthcare provider groups continue to consolidate. Small hospitals either get swallowed up by larger ones or risk going out of business. The federal government even seems to be encouraging provider consolidation, by establishing incentives for them to form accountable care organizations, or ACOs.

Standard economic theory holds that when firms gain too much market power, prices rise. Will that be the consequence of healthcare consolidation?

The short answer is: no one knows, because so much depends on the relative power of payers and providers in individual markets.

If consolidation was limited to providers, prices would rise (absent government intervention). For example, prices for total knee replacements have been shown to be higher in markets where orthopedic surgeons have bonded together in larger organizations. This is the finding of a study led by Eric Sun from Stanford University. Sun collected information on physician fees for this procedure, from a database of health insurance claims. He also figured out how competitive orthopedic markets are in different parts of the country. In some markets, patients can choose from a wide range of independent orthopedic surgeons. In more concentrated markets, their choices will be more limited, due to the existence of large orthopedic groups that account for a high proportion of local services. Patients in those more concentrated markets will face, on average, a $200 increase in the fee their surgeons charge for such services.

Merger Mania in Medicine -- What Will It Cost Us

The price of healthcare in the U.S. is determined in part by negotiations between payers and providers. When a large group of orthopedic surgeons commands a significant percent of business in a given area, they are in a good position to bargain for higher fees from local insurers.

What happens, then, when insurers gain market share? (To read the rest of this article, please visit Forbes.)

Posted in Uncategorized | Tagged , ,

Does Africa Have an Overeating Problem?


Posted in Uncategorized | Tagged

Would This Picture Help You Shop for a Doctor?

Attention all you design and #nudge fans. Here is a graphic from ProPublica that attempts to help people choose a physician.

Would This Picture Help You Shop for your Doctor

Do you think it works? What would you do to improve it?

Posted in Uncategorized | Tagged ,

What Gives Republicans Faith in Government?

President Ronald Reagan was famous for espousing anti-government views. To this day, he is lionized by Republicans, who frequently quote his “less is more” attitudes towards government. Which makes it kind of ironic that when he was in office, Republican faith in government rose significantly. In fact, when you ask people whether they trust the government to do what it ought to do, their answers are strongly influenced by whether the person in the White House shares their political allegiance:

Republican Faith in Govt

It also appears, according to recent trends, that Republican faith in government is much more volatile than that of Democrats. I’m sure that has a lot to do with how demonized the last two Democratic presidents have been, by Republican pundits. But interestingly, Democrats don’t seem to experience enormous increases in their faith in government when someone from their party is in office.

The world is an interesting place.

Posted in Uncategorized | Tagged ,

Look What Obamacare Has Done Now

The percent of Americans without health insurance has dropped precipitously in the last few years, thanks in large part to the Affordable Care Act, a.k.a. Obamacare. This is especially true in those states that, in accordance with the law, expanded Medicaid eligibility. Here is a picture of some recent data:

Look What Obamacare Has Done Now

This is really good news, and the figures are likely to continue improving over the next few years. But they will improve a lot more if holdout states agree to expand Medicaid.

I’m not holding my breath.

Posted in Uncategorized | Tagged , ,

Has Mammography Created an Epidemic of Pseudo-Survivorship?

Photo credit:

Photo credit:

Karen Vogt’s breast cancer journey began like many others, with her breasts painfully squeezed into a mammography machine. At age 52, it was far from her first mammogram, but this scan would be the most consequential by far. It revealed microcalcifications, little areas of breast tissue speckled with deposits of calcium that her radiologist worried were suspicious for a nascent cancer, especially since these specks hadn’t been so conspicuous twelve months earlier. A biopsy proved that the radiologist’s suspicions were warranted. Vogt had a small cancer in her left breast, a ductal carcinoma in situ, as her doctors called it. Stage 0 cancer. What should she do?

This week, medical researchers published a study showing that when women are diagnosed with stage 0 breast cancer, no matter what treatment they receive, their life expectancy is equivalent to women who were never diagnosed with breast cancer. This finding further fuels debates about whether we are screening for and/or treating breast cancer too aggressively. Last year, in fact, a study came out suggesting that even in women 50 years of age and older, annual mammographies are not the life-savers that they were made out to be by medical experts. According to these studies, for every woman like Vogt with a cancer detected by mammography, hundreds more will go through the painful test without any cancer being detected and dozens will experience the harms of “false positive” test results, a term medical experts use to refer to abnormal findings which do not turn out to be a cancer. And just this week, a study was published showing that stage 0 breast cancers are better off untreated

Yet despite increasing evidence of the significant harms of mammography, compared to its relatively modest benefits, many American women dutifully continue to receive annual tests. Why do they remain enthusiastic about mammography? In large part because many women who were harmed by mammography believe the opposite. By identifying non-invasive lesions, like the DCIS discovered in Karen Vogt, mammography has created a community of women incorrectly convinced that the test saved their lives.

Has overuse of mammography created a false epidemic of breast cancer “survivorship?” (To read the rest of this article, please visit Forbes.)

Posted in Uncategorized | Tagged , ,

Medicare, Schmedicare

For more than half a century now, the United States has stood out among its peers in the developed world for having the largest percent of its citizens living without health insurance. But once you turn 65-years-old in America, the government has you covered. Right?

Maybe not so much. Because even after people enroll in, they still end up with lots of out-of-pocket costs, costs that often burden them to the point where they can’t afford to receive care. Take these data from the Commonwealth Fund, which show the percent of people who have difficulty obtaining medical care because of cost:

Medicare Schmedicare

Once again, the U.S. stands as an outlier nation. Sometimes it’s not good being number one!

Posted in Uncategorized | Tagged , ,

Are You Overweight If Your Mom Thinks You Look Fine?

None of us view our children objectively. To a parent, Junior is always smarter, more talented and more attractive than objective evidence would indicate. But look at just how skewed parents’ views of their children are, when it comes to deciding whether their children are overweight. Not until a child gets near the top three or four percentile in body mass index do most parents begin to recognize that Junior has a problem.
Are You Overweight If Your Mom



Thanks to Pierre Chandon for this image. And thanks to my mom and dad, for convincing me that I was special.

Posted in Uncategorized | Tagged

Free: Boxed Set!

Photo Credit: OrganJet

Photo Credit: OrganJet

Back in June, I published a series of essays about efforts to fly people around the country to give them better access to life-saving organ transplants. For your convenience, I have pulled the three essays together into one PDF. As a teaser, I will remind you of the first few paragraphs of the essay. But if you click on this link, you can get access to the PDF: Your New Liver Is Only a Learjet Away by Peter Ubel.

The forty million dollar Gulfstream jet landed at Memphis International airport in the early morning hours, its schedule hastily arranged earlier that day from Northern California, where the flight originated. Waiting on the tarmac was Dr. James Eason, head of transplant surgery at Methodist University Hospital, who planned on whisking the passenger to the operating room for a liver transplant. The passenger rushed to Memphis not because he lived in Memphis and happened to be out of town when an organ became available, but rather because he knew that flying from his home in Northern California to Tennessee would give him his best chance of receiving a life-saving organ.

You see, the demand for transplantable livers in Northern California far outstrips the supply, meaning there is a decent chance a patient with end-stage liver disease will die before a replacement organ becomes available. But in Tennessee, the number of people waiting for a liver transplants is significantly smaller, per capita, than California, and as a result the supply of transplanted livers is much better matched to the demand for such organs. As a result of these geographic variations in supply and demand, patients in Northern California wait more than six years, on average, for a liver transplant, whereas the majority of patients in Tennessee receive new livers in less than three months.

That’s right: six years versus three months!

The passenger on the Gulfstream that morning was Apple co-founder and CEO, Steve Jobs. After being told he needed a liver transplant, Jobs had learned about the huge disparity in waiting time between California and Tennessee, and arranged to get placed on the transplant waiting list in both locales, knowing he could fly to whichever location came up with the first available organ. So when he got a call from Memphis explaining that a 20 year old man with a compatible blood type had died in a car crash earlier that day, he summoned his flight crew and made his way to Tennessee.

Steve Jobs walked out of the plane that morning a frail shadow of his former self. Pancreatic cancer had spread to his liver and, without a transplant, he had only weeks or months to live. Thanks to that early morning flight and the talents of his surgeon, Jobs received a transplant later that day and would survive two and a half more years, a time in which he introduced the world to the iPad and to a talking phone assistant named Siri.

It was wonderful for Jobs and his loved ones that he was able to receive a transplant that day. But was it fair that Jobs could afford to charter a jet from California to Tennessee to undergo a transplant, while thousands of equally sick Californians waited at home for livers that didn’t always come in time?

To read the rest of this article, please click on the PDF: Your New Liver Is Only a Learjet Away by Peter Ubel

Posted in Uncategorized