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How Much Will It Take To Improve Patient Safety?


One of the best lines in Jaws comes from Brody after he sees the 25-foot great white shark for the first time. He slowly backs into the cabin, looks at …

The Rush to Move Patient Care Out of the Hospital


Everyone wants patients out of the hospital, where the costliest of costly care takes place.  Government payers. Commercial health plans. Patients. Doctors. Even hospitals want patients out of the hospital. …

Will Misuse of Antibiotics Respond to Regulation?


I got my flu shot on Oct. 21. (I’ll let you know how it worked out.) As I waited for my turn at our nearby immediate-care center, I explained to …

Ranking the Regulations that Bother Doctors


I love healthcare industry regulatory burden surveys. From an academic standpoint, I’m interested in the topic of competition versus regulation and how each affects how healthcare markets function—or not—for patients. …

What Revolutionary Healthcare Leaders Are Reading: The Top 5 4sight Health Commentaries Over the Past Six Months


4sight Health’s writers and authors have published 57 blog posts, commentaries, podcasts and videos on 4sighthealth.com from January through June of this year. The topics are as varied as the …

Maybe It’s the Patients, Not the Prices. Is that Stupid?


In most markets for most goods and services, you get what you pay for. The more you pay, the better the goods or the services. Hence, the expression, you get …

Don’t Let Special Interests Block Pending Rules for Sharing Patient Healthcare Data


On September 23rd, the seven healthcare lobbyists listed below sent a letter to the leaders of the Senate Health, Education, Labor and Pensions Committee (HELP) and the House Committee on …

Seeing Through Physician Participation in Value-Based Reimbursement Models


The more things change, the more they stay the same.  I get the point of the expression. But, I didn’t fully appreciate how it applied to healthcare until I read …

Upselling in Healthcare? It’s Just Business


As wary consumers, we’ve come to expect upselling. Need an oil change? Looks like you need a new air filter and radiator flush, too. That sports coat looks fantastic on …

An American Inquiry: Why I Wrote The Customer Revolution in Healthcare


What convinced a former Peace Corps volunteer and healthcare investment banker like me that the U.S. healthcare system (the System) requires revolutionary overhaul? It really came down to just one …

Spend More. Pay More?


Everyone in healthcare is “all in” on a lot of things these days, and two things that are at or near the top of that list are social determinants of …

Should Doctors Make Less Money?


In an August 1st commentary published in the Washington Post, columnist Catherine Rampell asks an intriguing question of the Democratic presidential candidates promoting a Medicare-for-All health insurance program: “Will your …

The Rising Cost of Family Coverage Is No Joke


You might have heard about this on the news. A new study is out that says employer-sponsored health insurance is getting really expensive.  (How expensive is it?) Hmm. May your …

Desperately Seeking Market-Based Patient Safety Solutions – Burda on Healthcare


This Nov. 29 will mark the 20th anniversary of the release of the report, To Err Is Human: Building a Safer Health System, the seminal work by the Institute of …

How to Use Social Determinants of Health to Fix Reimbursements


Healthcare providers can no longer ignore the Social Determinants of Health (SDH) in the exam room. Even John Snow considered community assessment factors to identify the source of the cholera …

Should Hospitals Pay Taxes?


Many health systems and hospitals operate as Not-for-Profit (NFP), mission-oriented organizations that do not pay sales, excise, property or other taxes. In exchange, NFPs must publicly report the level of …

Surprise! Surprise! The Surprise Billing Legislation Could Usher in Government Price Controls. Nathan Bays, Guest Columnist


As the Senate Committee on Health, Education, Labor, and Pensions (HELP) prepares to vote on the Lowering Health Care Costs Act, the issue of surprise medical bills will take center …

States Foul-Tipping Regulatory Approaches to Control Healthcare Prices


A new Viewpoint in the Journal of the American Medical Association said states are trying, but largely failing, to control through various regulatory tactics the prices paid by private health …

Regulatory Chess: Positioning for Competitive Advantage


To entrepreneurs, regulation is the enemy of innovation. That’s especially true in healthcare. Experts agree that healthcare is one of the most, if not the most regulated industry in the …

Doctors and the Laws of Supply and Demand – Burda on Healthcare


It’s a great time to go to medical school and become a doctor. Ignore all the manufactured angst from organized medicine and opinion polls of aging physicians who say they …

Let’s Get Real: Medicare for All Can’t Work, but Affordable Health Insurance for All Can


As it has in the last three presidential elections, healthcare is emerging as a decisive political issue in the 2020 election. Unlike in those previous elections, however, universal health insurance …

This Is a Story About Where Healthcare Regulations Come From – Burda on Healthcare


Healthcare is one of the most if not the most regulated industry in the U.S. While its businesses like to blame overzealous bureaucrats for all the red tape, the current …

The Universal Patient Experience of Debilitating Healthcare Costs


The lack of affordable medical care isn’t just a U.S. phenomenon. It’s a serious problem across Europe, according to a new report from the World Health Organization. WHO’s report identified …

Opioid Variations and State Interventions


Like companies in any other industry, when providers misbehave, it opens the door to state regulation of their behavior. What’s interesting about a new study in JAMA Open Network is …

How Crony Capitalism in Healthcare Hurts Communities and Markets


Does “pro-business” equate to “pro-market”? Or is crony capitalism blurring the line in the healthcare industry? How can consumers tell if they are being treated fairly? There are two types …

Why Healthcare is Spinning Its VBR Wheels


It’s like preparing and serving a seven-course meal that your biggest customer ordered only to have the entire menu change between the salad and the main course. That’s what it …

When Hospitals Merge, Patient Satisfaction Gets Squeezed


When two competing companies merge and get bigger, a common worry of their customers is whether the quality of service will suffer as a result. Should patients worry about the …

Price Controls Take Root in Rhode Island. Will They Spread to Your State?


One state’s attempt to control healthcare costs by using “affordability standards” ended up limiting increases in commercial health insurance payments to hospitals and doctors without any changes in utilization or …

When Blue is the New Green


I mean, what did you think was going to happen? A new study says big Blues plans that went for-profit dramatically raised their premiums right after their ownership conversions. The …

The Immovable Force That Is Employer-Sponsored Health Insurance


Death, taxes and employer-sponsored health insurance. We know the first two are certainties in life, and new research again confirms the assurance of the third. Researchers from the School of …

Everyone Knows What’s Going to Happen in Healthcare in 2019. Do You?


What’s going to happen in healthcare this year is anyone’s guess. Not really. What’s going to happen in healthcare this year is everyone’s guess. Like most of you, from mid-December …

Medicare Advantage Bends Cost Curve the Wrong Way


Everyone sees what they want to see in the latest figures on national health expenditures released by the Centers for Medicare and Medicaid Services earlier this month. Most people see …

Eisenhower’s Prophesy: The Healthcare Industrial Complex (TM)


On January 17, 1961, three days before leaving office, Dwight D. Eisenhower spoke to the nation one last time as its president. Eisenhower’s observations about war, peace and democracy are …

HHS Goes All In on Competition as the Way to Fix Healthcare Woes


Competition good. Regulation bad. That’s my caveman summary of HHS’ manifesto released on Dec. 3 on how to improve the quality and safety of patient care while simultaneously lowering healthcare …

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Want Better Cardiac Outcomes? Just Follow the Money


The line between financial incentives and clinical outcomes just got a little straighter. A new study says money may have erased the difference in readmission rates between the top heart …

New Primary Care Provider, Same or Better Outcomes


Expanding the scope of practice for nurse practitioners and physician assistants may be a cost-effective way to manage the health of patients with chronic illnesses. That’s the market-based reform takeaway …

New Primary-Care Provider, Same Old Price


Patient office visits to primary care physicians are down. Patient office visits to nurse practitioners and physician assistants are up. But switching to NPs and PAs from doctors isn’t saving …

Amplifying Transformation: Addressing Medicare Advantage’s Disadvantages


The U.S. healthcare system will not change the way it delivers care until it changes the way it pays for care. Perverse incentives riddle fee-for-service payment (FFS) and lead to …

It’s Commercial Health Plans That Are Keeping Fee-for-Service Alive


Far from pulling the plug on fee-for-service medicine, commercial health plans continue to give it CPR. A new report says well over half of commercial health plan payments to providers …

Study Refocuses ER Coverage Debate on Patients


A new study reminds us that the squabble between providers and payers over coverage of unnecessary emergency room visits should be more about patients and less about who pays who …

Healthcare Worker Flu Vaccine Rates Offer a Lesson in Self-Policing


Short of making flu shots mandatory for healthcare workers, healthcare employers need to do much more to immunize their staffs from a virus that threatens their health and the health …

Against the Wind: Hospitals Challenge CMS’s Pro-Market Payment Reforms


Over the past month, the Centers for Medicare and Medicaid Services (CMS) announced several pro-market policies that will enhance pricing transparency, stimulate competition (and fair prices) for routine procedures and eliminate burdensome reporting requirements. …

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Kentucky HEALTH and Medicaid Work Requirements: A Behavioral Economics Lens Sheds Light


On Friday, June 29, near the zero hour, a federal judge ruled [1] that Kentucky’s Medicaid waiver approved by the CMS could not go forward on Sunday, July 1 as …

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CMS Misdirection: Two Troubling Decisions Damage Market Competitiveness


In well-functioning healthcare markets, governmental regulatory policies ensure access, safety, quality and privacy. The government’s most important role is creating level-field competition through balanced regulation, targeted enforcement actions and price/outcomes …

Pro-Market and Pro-Business: Not Always the Same, Particularly in Healthcare


Shortly after publishing Market vs. Medicine: America’s Epic Fight for Better, Affordable Healthcare in June 2016, I met with my former investment banking colleague, Jullia Quazi. Jullia arrived with a very funny story …

Is Tax-Exemption Necessary? Enlightened Health Systems Should Consider the Unthinkable


 In the mid-1800s, English philosopher and political economist John Stuart Mill developed “Utilitarianism,” a framework for making moral decisions. In Mill’s formulation, an action achieves optimal social utility when it …

Honey vs. Vinegar: Value-Based Pricing Wins Customers and Market-Share


Common wisdom holds that “it’s easier to catch flies with honey than vinegar.” That aphorism also applies to payers seeking lower prices for routine healthcare procedures. It “tastes” better when …

Taxing Consequences: House Republicans Target Tax-Exempt Hospital Bonds


Market Corner Commentary for November 21, 2017 Having failed to “repeal and replace” the Affordable Care Act, House and Senate Republicans have set their sights on reforming the U.S. tax …

Crony Capitalism Has Consequences: Opioid Distribution, Destruction and Death


Market Corner Commentary for October 25, 2017 – Special Edition Talk about bombshells. On October 15th, the Washington Post and 60 Minutes released a detailed and damning investigative report titled …

Senate Republicans Confront Their Healthcare Waterloo: Now What?


Last weekend Senators Jerry Moran of Kansas and Mike Lee of Utah announced they could not support Speaker Mitch McConnell’s Better Care Reconciliation Act of 2017 (BCRA). Their defections put …

Forming a More Perfect Health System: Senate Republicans Confront Their Policy Demons


Senator Mitch McConnell is the most effective Senate Majority Leader since Lyndon Johnson. A tactical maestro, McConnell faces the seeming impossible task of uniting the Republican party’s divergent conservative and …

“Indumbent” Healthcare Thinking: Prices Don’t Matter


In a March 29th New York Times article, author Elizabeth Rosenthal chronicles America’s dystopian system for coding and billing medical treatments. Rosenthal concludes that the medical-billing system itself is a …

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Trumpian Healthcare Reform: A “Silver Linings” Legislative Playbook


Special Edition: Market Corner Commentary for March 29, 2017 Last Friday was supposed to be the shootout at the healthcare corral where Republican gunslingers were going to take the first …

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The Rise and Fall of Academic Medicine: AMC Competitiveness in Post-Reform Healthcare


Rome wasn’t built in a day and didn’t collapse overnight. After centuries of growth, prosperity and domination, the Roman Empire began a long slow decline at the peak of its …

Healthcare’s Gettysburg Moment


Seven score and thirteen years ago this month (November 19, 1863), Abraham Lincoln delivered his renowned Gettysburg Address at the dedication for the Soldiers National Cemetery. With the ravages of …

Overturning Obamacare: A 5-Point Plan for President-Elect Donald Trump


Two weeks ago, I distributed a 5-Point healthcare plan for presumed President-elect Hillary Clinton. That was then. In a remarkable and unprecedented election surprise, Donald Trump defeated Hillary Clinton and …

HealthCare.Gov’s Death-Defying 2013 Launch: Implications for Government-Led Payment Reform


Enrollment for purchasing health insurance on public health exchanges began November 1st. Headlines for this fourth enrollment period include: 22% average price increases; major health insurers dropping coverage; and single …

Overhauling Obamacare: A 5-Point Plan for President-Elect Hillary Clinton


Absent a cataclysmic surprise next Tuesday, Hillary Clinton will become the 45th President of the United States. She will govern a divided electorate with highly-polarized elected officials. It’s no longer …

Value Quest: Capital Formation Challenges for Non-Profit Health Systems


by David W. Johnson, James Moloney and Carsten Beith   There’s a battle outside and it’s ragin’ It’ll soon shake your windows and rattle your walls For the times they …

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Market Evolution: Addressing Structural Flaws on Public Health Exchanges


After two-plus years of operations, clear structural flaws have emerged in the design and function of public health exchanges. Health insurance cooperatives have largely failed. Many traditional insurers have suffered …

health care services

Epi(c) Pharmaceutical Market Failure


It was hard not to feel sorry for Mylan CEO Heather Bresch as she sat for an extended CNBC interview on the morning of August 25th. Clearly on the hot …

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Obama Speaks: A Presidential Assessment of Obamacare


Market Corner Commentary for July 27, 2016 Earlier this month, President Obama took the unprecedented step of authoring an academic research article in The Journal of the American Medical Association …

4sight Health

Now You See It…. The Unreliability of Government Student Loan Forgiveness


Each October, the Association of American Medical Colleges (AAMC) publishes its “Debt, Costs and Loan Repayment Fact Card”. It surveys recent medical school graduates and details the amount and composition …

Dynamic Tension: Rethinking Health System Governance


Market Corner Commentary- Health System Governance- for January 6, 2015 John Koster MD and David Johnson The winds of post-reform transformation are blowing through healthcare. Long-established health systems confront existential …

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Of Metrics and Meaning: Making Sense of Healthcare Quality Ratings


Market Corner Commentary for September 9, 2015-Of Metrics and Meaning: Making Sense of Healthcare Quality Ratings As healthcare becomes more consumer-focused, hospital and physician rating systems are proliferating.  Yelp is …

Individual Mandate: Are You Up for N=1 Healthcare?


Market Corner Commentary for August 19, 2015 (disruption)-Individual Mandate: Are You Up for N=1 Healthcare? Yogi Berra famously observed, “The future just ain’t like it used to be.”   In N=1: How …

Supreme Court vs. Obamacare II: Decision Time


This article first appeared in Huron Perspectives on June 2, 2015-Supreme Court vs. Obamacare II: Decision Time The “Thrilla in Manila” in 1975 was Mohammad Ali and Joe Frazier’s second …

Supreme Court vs. Obamacare II: High Drama; Not the “Main Event”


The “Thrilla in Manila” in 1975 was Mohammad Ali and Joe Frazier’s second championship fight. In 1967, Ali refused conscription as a conscientious objector. He was convicted of draft evasion, …