Author: Nikhil Bhojwani

Recon takes an analytical look behind select developments in healthcare

Emerging Unintended Consequences of Health Care Reform

In complex system, even small changes can have big, unexpected consequences.  These are occasionally beneficial but more often than not have a negative impact.     Over the last year we have started to see some evidence for unintended consequences from the health care reform act.  Negative impacts that we see are of two kinds: Perverse effects that directly affect the objectives of the act and side-effects that manifest in seemingly unrelated areas (see figure below). It is not the intent here to comment on the overall merits or demerits of

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Conventional wisdom that provider capacity drives cost questioned in new study

Remember the idea that coordination will improve care? Well, if physicians do not get timely reports from other providers, their patients seem to have lower costs!!!  This from a new study out from the Center for Studying Health System Change.  More importantly, this paper throws cold water on the idea that providers generate a lot of unnecessary cost to fill up excess capacity in the delivery system.   As you know, conventional wisdom driven by the Dartmouth Atlas and other studies has it that that care utilization and cost can vary sharply across regions without

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Surprising implication of drivers of Medicare FFS variation – MedPAC

New MedPAC report on Medicare fee for service utilization finds large geographic variation not explained by underlying risk or better outcomes. Another indicator of our HC system gone haywire.    A couple of overarching datapoints highlight the variation.  Only 25% of Medicare enrollees live in regions where Medicare spending is within 5% of the national average (looking only at utilization the # is 30%) Spending in top decile region was 55% greater than spending in the bottom decile region (looking only at utilization, the # is 30%) But that is not the

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Health care reform not so easy to derail

Prediction 1: Despite all the beating of drums we do not think there will be any major legislative changes between now and 2012. controlling the house but not the senate and the White House does not give Republicans sufficient clout to fundamentally change the bill it is politically advantageous for the Republicans to keep the Democrats on the defensive on health care through the 2012 election cycle Prediction 2: Administrative proceedings with implementation of the big milestones will continue though there will be considerable friction and much name calling some

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If you’re on Medicare – don’t fall sick

A friend of mine pointed out some shocking data from a report released today from the Office of Inspector General. More than a quarter of Medicare hospitalizations result in adverse events, half of them “serious” (meaning prolonged hospital stay, permanent harm, need for life sustaining intervention, death).  Strikingly, almost half these situations arise are preventable.  In other words they are the result of medical errors, sub-standard care, lack of patient monitoring and assessment and hospital acquired infections!  According to the study, these cost the taxpayer over $4 billion in 2008

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