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EPM presents a weekly rundown of critical reads from around the web, along with commentary by EPM senior editors. This week, we look at stories from Pacific Standard, Fortune, and Vox about football-related brain injuries, Walmart's latest foray into medical marketing, and quality-based pay for healthcare providers.

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IS IT THE BEGINNING OF THE END OF FOOTBALL?

Original article: PSMag: Will Football and CTE Give Way to Futbol and Do Re Mi?

Nick Genes, MD, PhD: As NFL football gears up and EPM runs an article on safely removing gear before evaluating a patient -  this issue of concussions and imagining an America without football is interesting. It would take a generation, but gradually, concerned parents keeping their kids of out concussion-prone sports may severely curtail this pastime. And it's worth considering another angle  - already a player in arena football was killed, on camera - if something like that happened on Monday Night Football, it would be pretty hard to go back to business as usual.

William Sullivan, MD: Read some of the articles/studies cited in the article and you'd be hard-pressed not to be asking the same questions.

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WALMART: THE NEXT BIG NAME IN PRIMARY CARE

Original article: Fortune: Can Walmart help to solve the U.S. healthcare-access crisis?

William Sullivan, MD: Walmart's medical marketing innovations continue. Walmart changed the prescription medication landscape with its $4 medication list and caused the market to follow suit. How will the market react if supermarket medicine gains traction? $40 per appointment will undercut the costs of many physician office visits, but with the decreased price will there be any effect on quality? EMR choice will be a HUGE game-changer by itself. Will there be a pricing showdown between Walmart and CMS if WalMart gains a larger patient market share and can then use its size to begin demanding increased reimbursement for services?

Nick Genes, MD, PhD: Unlike the minute-clinics that have sprung up at drug stores, Wal-Mart is piloting true primary care clinics in rural areas, which could address the problem of "access" to healthcare (now that the ACA has added millions to the ranks of the insured). Even if they only end up treating Walmart employees, that could still be a boon in underserved areas. And I'll be very curious to see the electronic health record system they choose.

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ARE "PAY FOR QUALITY" MODELS UNWORKABLE?

Original article: Vox: This big hospital pay-for-performance program failed in year one

William Sullivan, MD: I have always believed that a "pay for quality" idea would fail because it will encourage providers to shift their attention only to the quality measures being measured. Better question based on this article is "why" the project failed. Were incentives not large enough? Were metrics chosen for quality measures inappropriate? Is there just not that much room for improvement given the inexact science of medical care? Has medical quality already reached a "ceiling"? Or are the incremental costs involved in increasing quality by a small amount not worth the potential gains?

 

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