Ben Agar

One of the byproducts of Obamacare and its new set of incentives in healthcare is the shifting of all the power to the administrators. The hospital working environment has changed dramatically, with physicians and staff “feeling” the new-found power of administrators. The administrators now call most of the shots and frequently play rough-shod over the feelings and opinions of the physicians and experienced hospital staff. The mistreatment of physicians and experienced clinical staff by administrators is nearly universal, raising questions about the motives behind it. In this article, we discuss the various potential motivations for the administrators to keep the physicians and staff in state of constant fear. Read Full Article

Ben Agar

Encouraging quality in healthcare is the new ‘mantra’ nowadays. In a typical bureaucratic fashion “quality promotion initiatives” such as PQRS and MACRA have been rolled out to improve quality. These initiatives have never been proven to be beneficial but such empirical bureaucratic approach is not surprising now that the ‘control’ of healthcare is completely outside the control of physicians and firmly in the hands of politicians, bureaucrats and hospital administrators. Most of those involved in creating these “innovative” quality promotion initiatives have little or no understanding of the incentives in healthcare but they still feel qualified to do so. This article discusses how ‘excellent clinicians’ have systematically been undervalued in our healthcare system. To most, it would be surprising since commonsense would dictate that clinical excellence and therefore ‘excellent clinicians’ are central to delivering high quality healthcare. But like everything else in our healthcare system, this is just another “phenomenon” that defies logic. But understanding it and correcting it will be more effective in improving the quality of our healthcare than those attractively named initiatives which have so far been complete fiascos and have only served to take attention away from ‘real quality in healthcare’ Read Full Article

Ben Agar

Payors (CMS and insurance companies) are increasingly and now incessantly talking about ‘rewarding’ quality in healthcare. To be able to do so, they are developing ‘quality measures’ to compare physicians and hospitals. Their definition of quality is different from what has traditionally been considered quality by patients and physicians. The ‘quality measures’ devised by payors in healthcare are now being aggressively being marketed as true measures of quality. The hospitals and physicians have changed their practice patterns to look good on these new ‘quality parameters’. The biggest casualty of this new push for quality has been the ‘real’ quality in healthcare, which cannot be measured directly and hence is increasingly being neglected. This article discusses what ‘real’ quality is in healthcare, how it has traditionally been communicated to patients in healthcare marketplace, and why this communication has failed in present day healthcare. Read Full Article

Ben Agar

Increasing number of surgeries and medical procedures is driving healthcare costs at an unsustainable pace. Insurance companies try to limit use of surgeries and medical procedures by placing restrictions which hassle the patients and physicians. However, such measures have had limited impact and only serve to increase the administrative cost for the insurance companies as also the physician practices, which in turn further increase the cost of healthcare delivery. A root cause analysis could help identify the incentives that drive marginally indicated surgeries and procedures. Policy makers could then design appropriate measures to change incentives for physicians to help rectify this problem. This could not only result in large healthcare savings but also improve the quality of care by obviating the morbidity and mortality related to the marginally indicated surgeries and procedures. A ‘Five Why’ analysis was performed to get to the root of this problem. Read Full Article

Ben Agar

There is an intense debate now about reforming our "dysfunctional" healthcare so that it again becomes affordable and retains it "high quality". After several decades of meddling by policy-makers and powerful lobbyists for middlemen (drug companies, insurance companies, hospital associations etc), healthcare has increasing dysfunctional and progressively more un-affordable. It is so bad that now even the upper middle class finds it difficult to afford healthcare. The horrible track record of policy interventions by the "well-meaning" politicians and economists and the powerful middlemen has not dissuaded another round of "policy interventions" to "save" our healthcare system. The politicians and economists are not in the habit of assessing the results of their policy prescriptions and therefore will not own up to their role in why our healthcare is so dysfunctional and un-affordable. The middlemen who have usurped all the power in healthcare marketplace are now about to kill the goose that lays golden eggs. And the patients and physicians have no say in this and are forced to be onlookers from the sidelines. Read Full Article

Ben Agar

Till recently, it was not difficult for patients to find and reach genuine experts to take care of their healthcare needs. They could just go to a “good and reputed” hospital or ask their primary care physician for recommendations. The incentives in the system were such that patients in need of special expertise or high level of expertise were sooner or later referred to appropriately trained and expert physicians. Since the advent of Obamacare, the incentive structure in healthcare has changed dramatically and going to a good hospital or asking your trusted PCP will not get you the best physician for your needs nor are patients who require complex surgery or medical procedure referred to the most capable surgeon or proceduralist in the area. Read Full Article