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The Flap About the Dartmouth Atlas

Earlier in June, the New York Times ran an article by Adleson and Reed questioning the findings in the Dartmouth Atlas. Jack Wennberg and colleagues have been working in this field and documenting small area variation in health care since the 1970s. However, the work was not much recognized outside of academic and health care analytic circles until the start …

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Cover Michigan 2010

Today, we are releasing our 2010 report on health care coverage in Michigan. This report includes comprehensive data on the uninsured, publicly, privately insured and the safety net. In addition, we have included a final chapter on what could be the impact of health reform on coverage in Michigan. The 2010 report principally includes data from 2007/8, the most recently …

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Smorgasbord Anyone?

The recently passed “Patient Protection and Affordable Care Act” a/k/a “health care reform” is a monumental piece of legislation, both literally and figuratively. Despite its supposed intent to “reform” the health care system, however, it is quite tepid on reform and very aggressive on enhancing coverage. The legislation contains a virtual smorgasbord of programs, directives, initiatives, instructions, orders, regulations, requirements, …

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Creating Focus and Building on the Opportunity of Health Reform

As I’ve said in past posts, health care reform is much more about insurance reform of the health insurance system than it is about real and fundamental change to the health care delivery or public health systems (see “The Case of the Missing $115 Billion”). The bulk of the dollars included in the Patient Protection and Affordable Care Act (PPACA) …

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The Health Care Industry in Michigan: Staying on the Open Road

When I first came to Michigan from Indiana a year ago, I knew I was coming to a special state for health care. Impressively, hospitals across Michigan have topped the national charts for years when it comes to providing high-quality health care. And compared with most states, Michigan has a long history of innovative pharmaceutical and medical research, excellent private …

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The Case of the Missing $115 billion

The printed version of the final health reform Act (PL 111-148) comes in at 907 pages (yes, lots of white space and pretty small pages – and yes, including an detour into student loans – but still, a very big Act any way you look at it). Many have noted the sweeping nature of the Act and how it touches …

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The Wrong Policy: Physicians, Medicare Payment, and What Congress Could Learn from Private Sector Experience

Bruce Vladeck has a terrific piece in this week’s New England Journal of Medicine describing the problems with how physician fees are currently adjusted under Medicare. The Sustainable Growth Rate (SGR) formula, put in place in by Congress in 1997 – was designed to use physician fees as a tool to control health care spending. That is, total physician payments …

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The Paradox of Accountable Care Organizations

In the run up to health care reform, there was considerable discussion and advocacy for the idea of encouraging the implementation of something called accountable care organization (ACOs). Count me as a hope-to-be proved-wrong skeptic of this idea. The definition of an ACO is somewhat vague. Essentially the idea is to have groups of providers (group practices, individual providers, hospitals) …

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A Challenge and an Opportunity: Health Reform at the State and Local Level

Many commentators have noted that the success or failure of health reform will be determined by how well it is implemented by the Department of Health and Human Services – in particular, the Centers for Medicare and Medicaid (CMS). There is no question this issue is critical, and it is precisely why HHS is quickly issuing regulations for the elements …

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