How to Optimize Your Life With a Simple Block Schedule

Are you instantly overwhelmed by the sheer number of items on your to-do list? Are to-dos and appointments slipping through the cracks? Are you a mom wearing many hats, always struggling to keep yourself pointed in the right direction? Do you have a fair amount of flexibility in your life/school/work and need to create your …

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Health in 2 Point 00, Episode 152 | 2 IPOs, At-Home Care, & Youtube for Employees?

With 2 IPOs this week, On Episode 152 of Health in 2 Point 00, Jess asks me about Amwell’s IPO with a market cap at $5B for its telehealth solutions, Outset Medical’s IPO with a market cap of $1.5B for its kidney dialysis technology, Ready raising $54M for its care at- home platform, Lifespeak getting $42M for its “YouTube” like platform for employee mental health and wellness training program.Matthew Holt

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If I Can Be Safe Working as An ER Doctor Caring for COVID Patients, We Can Make Schools Safe for Children, Teachers, and Families


We need to stop arguing about whether schools should reopen and instead do the work to reopen schools safely. Community prevalence of COVID-19 infection helps to quantify risk, but reopening decisions should not be predicated on this alone. Instead of deciding reopening has failed when an infected student or teacher comes to school, we should judge efforts by our success in breaking transmission chains between those who come to school infected and those who don’t. We should judge our success by when we prevent another outbreak. We should pursue risk and harm reduction by layering interventions to make overall risk of transmission in schools negligible. This CAN be done, as healthcare workers all over the United States have shown us. Unlike politics, we should avoid thinking this is a binary choice between two polarized options. At the heart of these decisions about tradeoffs should be the assumption that the education of our children is an essential, public good.

I advocated for school closures in March. We had little understanding of the risks and transmission of COVID-19 and faced massive shortages of personal protective equipment (PPE). The closures were a blunt force instrument but bought precious time to learn and prepare. Pandemic control, by flattening the curve and buying time for discovery of more effective therapeutics, care and a vaccine, remains a critical tool to save lives. But COVID-19 will not be eradicated. We must come to terms with the reality that COVID-19 will circulate among us, likely indefinitely. Shutdowns slow spread but at a great cost, disproportionately paid by vulnerable groups including children, women, minorities, and those with the least financial resources. Getting children safely back to in-person school should be among our highest priorities.

Hospitals never considered closing. As healthcare workers, we cannot physically distance from patients. We watched in horror as hot spots like Bergamo suffered high nosocomial and staff infection rates as they were quickly overwhelmed. In response, we worked tirelessly and collaboratively to protect one another while continuing to provide care.

The good news is that we seem to have learned how to prevent in-hospital transmission of COVID-19. A recent study showed that at a large US academic medical center, after implementation of a comprehensive infection control policy, 697 of 9,149 admitted patients were diagnosed with COVID-19. But only TWO hospital-acquired patient infections were detected. COVID-19 is not “just the flu,” but it isn’t Ebola either. I no longer worry that I will become infected with COVID while working in my emergency department. It is not easy, comfortable nor cheap, but a bundle of universal masking and eye protection, appropriate PPE use, sanitation, improved room ventilation, and protective policies have proven effective at preventing in-hospital outbreaks. 

While necessary in the spring, school closures were devastating. As a mom of four young children, I can tell you that education cannot be replicated in a virtual format for most young children. Stable high-speed internet and devices are minimum requirements, but far from sufficient. Parents, disproportionately women, spend entire days helping children navigate clunky technology. We spend maddening hours badgering our young learners to join up and engage while we struggle to keep younger siblings from distracting them. Getting our own work done at the same time is impossible. And these are challenges faced by parents who are able to telecommute. It is telling that, even with the best resources to meet the challenges of virtual school, the most privileged families are forming pods and hiring private tutors or enrolling in private schools.

The challenges faced by those without financial means and other advantages must be overwhelming. Can you imagine being a single parent, unable to work virtually, and trying to get your 2nd grader to do their online school while you are at work? Without reliable internet or devices? Without the benefit of English as your first language? There are data showing that 90% of high income students accessed online learning versus just 60% of low-income students. Low-income families are not lazy. They do not value education less. But they lack the privilege to demand better or to pay for something better. We are failing these children by not reopening the schools.

The harm caused by the continuing loss of in-person instruction will be, like many aspects of the pandemic, hugely disparate. We absolutely need to offer high quality virtual options for families at the greatest risk from COVID-19. But, for many children, virtual learning will mean a year without learning — a lost year that will widen the enormous gap between the privileged and the disadvantaged. The impact of the loss of education may follow these children for a lifetime as the cost of these inequities could compound over the years. 

Six months into the pandemic, we know a lot more about COVID-19, and we should know better than to sacrifice in-person school simply because it is the easiest solution for pandemic control. We now understand that there is heterogeneity of risk for transmission and serious illness. Instead of using community spread as a trigger to close schools, communities should identify the threshold at which other high-risk, non-essential adult recreational activities and venues, like indoor bars, should be closed. Measures should protect the most vulnerable and be layered on to reduce cumulative risk. Schools can adopt much of what was done in hospitals. Cohorting and encouraging employees to take sick leave has helped. This can be done with students and teachers too. Adherence to universal masking, even of people without symptoms, has proven critical to interrupt transmission chains among workers and between patients and workers. Eye protection adds another layer of defense. Negative pressure ventilation allows us to safely perform high-risk aerosol-generating procedures without becoming ill ourselves. Negative pressure would be difficult to implement in schools, but improved ventilation and air filtration in schools could provide similar protections. Identification of an effective, protective bundle of measures that reliably prevents outbreaks will enable kids to stay in school rather than suffering a disruptive revolving door of quarantines.

School staff, like health care workers, are essential. We must provide them with money, expertise, and resources to optimize air quality in buildings, make space for distancing and provide adequate PPE and sanitation. They deserve maximum protections. It is possible to make in-person school safe again, and we should neither deny the risks nor descend into nihilism. Our communities should come together to do what it takes to prevent the collapse of education. Failure should not be an option. 

Dr. Amy Cho, MD MBA is a practicing emergency physician, policy and legislative advocate, and mom of four young children. This post originally appeared on LinkedIn here.

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THCB Gang Episode 25 9/17 LIVE from 1PM PT/4PM ET

Episode 25 of “The THCB Gang” will be live-streamed on Thursday, September 17th from 1PM PT/4PM ET! Watch it below!

Joining Me (@zoyak1594) are some of our regulars: radiologist Saurabh Jha (@RougeRad), patient advocate Grace Cordovano (@GraceCordovano), writer Kim Bellard (@kimbbellard), policy & tech expert Vince Kuraitis (@VinceKuraitis), data privacy expert Deven McGraw (@healthprivacy), and guest Rosemarie Day, Founder & CEO of Day Health Strategies (@Rosemarie_Day1). The conversation will revolve around the new policy regarding COVID19, the 2020 election, environmental factors & health care, and a whole lot more!

If you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan

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Doctors Urge Caution in Interpretation of Research in Times of COVID-19

September 9, 2020


American College of Cardiology

American College of Chest Physicians

American College of Physicians

American College of Radiology

American Heart Association

American Society of Echocardiography

American Thoracic Society

European Association of Cardiovascular Imaging

European Society of Cardiology

European Society of Radiology

Heart Rhythm Society

Infectious Disease Society of America

North American Society of Cardiovascular Imaging

Radiologic Society of North America

Society of Cardiovascular Magnetic Resonance

Society of Critical Care Medicine

Society of General Internal Medicine

Society of Hospital Medicine

Dear Society Leadership:

We are a group of clinicians, researchers and imaging specialists writing in response to recent publications and media coverage about myocarditis after COVID-19. We work in different areas such as public health, internal medicine, cardiology, and radiology, across the globe, but are similarly concerned about the presentation, interpretation and media coverage of the role of cardiac magnetic resonance imaging in the management of asymptomatic patients recovered from COVID-19.

Studies1–3 investigating the prevalence of myocarditis in patients with recent COVID-19 have found features of subclinical myocarditis on cardiac magnetic resonance (CMR) imaging in patients without symptoms. Some commentators have raised concern that COVID-19 may lead to frequent, serious long-term cardiac sequelae even among people who have had mild infection and are currently asymptomatic.

We wish to emphasize that the prevalence, clinical significance and long-term implications of CMR surrogates of myocardial injury on morbidity and mortality are unknown. Further, it is unclear if the elevated T1 and T2 flagged in these studies are clinically significant, particularly in isolation, if treatment is needed, and, if so, what the management should be.  These important questions should inspire future prospective studies.

Nonetheless, these reports have attracted significant media coverage, at times amplified by speculation on possible clinical implications, thus generating substantial anxiety amongst members of the general public. As a result, we are aware that some individuals are seeking CMR testing despite the absence of cardiac symptoms. We believe that, given the preliminary nature and limitations of the current evidence, testing asymptomatic members of the general public after COVID-19 is not indicated outside of carefully planned and approved research studies with appropriate control groups.

In light of your societies’ standing in the community and advocacy against low-yield testing and low-value medical care through your sponsorship of the Choosing Wisely4, Image Wisely5, and other similar campaigns, we request that you offer clear guidance discouraging CMR screening for COVID-19 related heart abnormalities in asymptomatic members of the general public.


Venkatesh L. Murthy, MD, PhD, FACC, FAHA

Rubenfire Professor of Preventive Cardiology

Division of Cardiovascular Medicine

University of Michigan, Ann Arbor

Ann Arbor, MI USA

Daniel J Morgan MD, MS, FIDSA, FSHEA

Professor of Epidemiology and Public Health and Infectious Diseases

University of Maryland School of Medicine

Chief Hospital Epidemiologist, VA Maryland Healthcare System

Baltimore, Maryland USA

Vinay Prasad MD MPH


San Francisco, CA, USA

Edward J. Schloss, MD, FHRS

Division Chief, Cardiac Electrophysiology

The Christ Hospital

Cincinnati, OH USA

Stephen A. McCullough, MD

Assistant Professor of Medicine

Department of Medicine, Division of Cardiology

Weill Cornell Medicine / NewYork-Presbyterian Hospital

New York, NY USA

Christos Argyropoulos, MD, PhD, FASN

Division Chief, Nephrology,

University of New Mexico School of Medicine,

Albuquerque, NM USA

Ibrahim Halil Tanboga, MD, PhD

Professor of Cardiology and Biostatistician

Nisantasi University & Hisar Intercontinental Hospital, Department of Cardiology, Istanbul

Ataturk University, Medical School, Department of Biostatistics, Erzurum, Turkey

David L. Brown, MD

Professor of Medicine

Washington University School of Medicine

St. Louis, MO USA

Ritu Thamman MD

Assistant Professor of Medicine

University of Pittsburgh School of Medicine

Pittsburgh, PA USA

Zainab Samad, MBBS, MHS

Professor of Medicine,

Aga Khan University, Karachi, Pakistan

John Mandrola, MD

Cardiac Electrophysiologist

Baptist Health Louisville

Louisville, KY USA

Ethan J. Weiss, M.D.


San Francisco, CA USA

Rohin Francis, MBBS

Cardiology specialist trainee

Essex Cardiothoracic Centre

Basildon, UK

Rory Hachamovitch, MD, MSc, FACC, MASNC

Staff Cardiologist

Cleveland Clinic

Cleveland, OH USA

Jeremy B Sussman

Associate Professor Of Medicine

University of Michigan

Ann Arbor, MI USA

Marcio Sommer Bittencourt MD, MPH, PhD, FACC, FESC, FAHA

Staff Cardiologist

Department of Internal Medicine

University Hospital – University of Sao Paulo

Sao Paulo – Brazil

David J. Cohen, MD MSc

Professor of Medicine

University of Missouri-Kansas City

Kansas City, MO USA

Joshua E. Levenson, MD FACC

University of Pittsburgh Medical Center Heart and Vascular Institute

Pittsburgh, PA USA


Consultant Cardiologist

Southampton General Hospital, UK

President, British Heart Valve Society

Fernando G Zampieri, MD, PhD


Research Coordinator, HCor Research Institute, São Paulo, Brazil

Leticia Kawano-Dourado, MD, PhD

Respiratory medicine physician and researcher

HCor Research Institute, São Paulo, Brazil

Pulmonary Division, Heart Institute (InCor), Medical School of the University of Sao Paulo, Sao Paulo, Brazil

INSERM UMR 1152 – University of Paris Diderot, Paris, France

João L. Cavalcante, MD, FACC, FSCMR

Imaging Cardiologist and Director of Cardiac MRI and Structural CT Labs

Minneapolis Heart Institute, Minneapolis, MN, USA

Florian Zores, MD


Specialized Medical Center & Ellipse Center

Strasbourg, France

Adam Cifu, MD

Professor of Medicine

University of Chicago

Chicago Il, USA

Ash Paul MPH, FFPH

Consultant in Public Health

NHS South West London CCG

London SW19 1RH



Staff Cardiologist

Associate Professor of Medicine, Case Western Reserve University

MetroHealth Medical Center

Cleveland, OH USA

David R. Tomlinson BM BSc MD

Consultant Cardiologist and Electrophysiologist and MedRxiv Affiliate

University Hospitals Plymouth NHS Trust

Plymouth, UK USA

Michael E. Johansen MD MS

Assistant Residency Director

Grant Family Medicine

Columbus, OH USA

Joseph Selvanayagam MBBS (Hons) FRACP DPhil FESC FSCMR

Professor of Cardiovascular Medicine, Flinders University

Senior Consultant Cardiologist, Director of Imaging, Flinders Medical Centre

Adelaide, Australia

Brett W. Sperry, MD

Assistant Professor of Medicine, University of Missouri – Kansas City

Saint Luke’s Mid America Heart Institute

Kansas City, MO USA

Martin Ugander MD PhD

Professor of Cardiac Imaging

University of Sydney

Sydney, Australia

Jason H. Wasfy, MD MPhil

Director, Outcomes Research, Massachusetts General Hospital Heart Center

Assistant Professor, Harvard Medical School

Boston, Massachusetts USA

Constantine Raptis, MD

Director of Thoracic MRI and Co-Director of Emergency Radiology

Associate Professor of Diagnostic Radiology

Mallinckrodt Institute of Radiology

Washington University, St. Louis

St. Louis, MO USA

Eric Strong, MD

Associate Professor of Medicine

Stanford University

Stanford, CA USA

Leon Menezes, BA BM BCh FRCR FRCP

Consultant Radiologist & Nuclear Medicine Physician

UCL Institute of Nuclear Medicine and Barts Heart Centre, London UK

Lead Nuclear Cardiology UCL Partners

Will Watson, MB BChir

Specialist Registrar in Cardiology


United Kingdom

Edward J. Miller, MD PhD, FASNC, FACC

Associate Professor of Medicine (Cardiology) and Radiology & Biomedical Imaging

Director, Nuclear Cardiology

Director, Cardiology Fellowship Program

Yale University School of Medicine

New Haven, CT USA


Professor of Clinical Cardiology

University of Edinburgh

United Kingdom

Evelyn M Horn MD

Director Advanced Heart Failure and Pulmonary Vascular Disease

Professor of Clinical Cardiology

Weill Cornell Medicine

Saurabh Jha MBBS MRCS MS

Associate Professor of Radiology,

University of Pennsylvania

Juan C. Lopez-Mattei, MD, FACC, FASE, FSCCT, FSCMR

Associate Professor, Department of Cardiology

Adjunct Associate Professor, Department of Thoracic Imaging

Co-Director, MD Anderson Cardiac Radiology Services

University of Texas MD Anderson Cancer Center

Dorian L, Beasley, MD, FACC

General and Interventional Cardiology

Indianapolis, Indiana

Erik Schelbert, MD, MS, FACC

Director, Cardiovascular Magnetic Resonance

Associate Professor of Medicine

University of Pittsburgh School of Medicine

Bogdan Enache MD


Princess Grace Hospital


David Nunan PhD

Centre for Evidence-Based Medicine, University of Oxford

Oxford, UK

Brahmajee Nallamothu, MD, MPH

Professor of Internal Medicine

University of Michigan Medical School – Ann Arbor

Yiannis S. Chatzizisis, MD, PhD

Professor of Medicine, Physiology and Engineering                    

Chief, Interventional Cardiology Section

Director, Cardiac Catheterization Laboratory

Director, Heart and Vascular Unit

Director, Cardiovascular Biology and Biomechanics Laboratory

Cardiovascular Division, University of Nebraska Medical Center, Omaha, NE, USA

Raj Mehta, MD

Family Medicine & Clinical Informatics

Assistant Program Director, Family Medicine Residency


Winterpark, FL USA

Saurabh Malhotra MD MPH FACC FASNC

Imaging Cardiologist

Director of Advanced Cardiac Imaging and Cardiac Stress Testing Laboratory, Division of Cardiology, Cook County Health

Associate Professor of Medicine (Cardiology), Rush Medical College

Chicago, IL, USA

Shelby Kutty, MD, PhD, MHCM

The Helen B. Taussig Professor

Director, Pediatric and Congenital Cardiology

Co-Director, Blalock Taussig Thomas Heart Center

Johns Hopkins University School of Medicine

Ali N Zaidi, MD

Director, Mount Sinai Adult Congenital Heart Disease Center

Director, Academic Affairs, Childrens Heart Center, Kravis Children’s Hospital

Associate Professor, Medicine and Pediatrics

Ichan School of Medicine at Mount Sinai, New York, NY


Hugh Monroe Wilson Professor of Radiology

Professor of Biomedical Engineering

Sr. Vice Chair, Radiology Research Facilities

Director, Cardiac MRI/CT

Mallinckrodt Institute of Radiology

Washington University School of Medicine

St. Louis, MO, USA


1.   Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, Shchendrygina A, Escher F, Vasa-Nicotera M, Zeiher AM, Vehreschild M, Nagel E. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol [Internet]. 2020;Available from:

2.   Huang L, Zhao P, Tang D, Zhu T, Han R, Zhan C, Liu W, Zeng H, Tao Q, Xia L. Cardiac Involvement in Patients Recovered From COVID-2019 Identified Using Magnetic Resonance Imaging. JACC Cardiovasc Imaging [Internet]. 2020;Available from:

3.   Clark DE, Parikh A, Dendy JM, Diamond AB, George-Durrett K, Fish FA, Fitch W, Hughes SG, Soslow JH. COVID-19 Myocardial Pathology Evaluated Through scrEening Cardiac Magnetic Resonance (COMPETE CMR). medRxiv. 2020;2020.08.31.20185140.

4.   Cassel CK, Guest JA. Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA. 2012;307:1801–1802.

5.   Brink JA, Amis ES. Image Wisely: a campaign to increase awareness about adult radiation protection. Radiology. 2010;257:601–602.

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375: How to Breathe the Right Way (& Why It Matters!) With Max Gomez From Breathwrk

It wasn’t one of the first health hacks I tried, but it’s impossible to ignore the stress-reducing benefits of using the breath to calm the body. Max Gomez is my guest today, and he’s the co-founder and CEO of Breathwrk, a wellness company dedicated to teaching people breathing exercises for stress reduction, anti-anxiety, and more …

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Kids & Mental Health: Brightline Aims to “Grow Up” Pediatric Behavioral Health Care with Tech


Despite the fact that kids make up 20% of our national patient population and that their parents are likely just the tech-savvy market of health consumers that most digital health companies are targeting with their own virtual care solutions, very little has been done to use technology to ‘transform’ the way that they take care of their kids. One of the founders hoping to push this market into a growth spurt is Naomi Allen, co-founder & CEO of pediatric behavioral health company Brightline.

From seed to Series A in just 8 months ($25M total funding), Brightline is already looking to scale out its full-stack clinical model to help tackle the behavioral health issues that are often under-diagnosed and under-treated in kids. Naomi says that 75% of all severe mental illness manifests before age 14, but that only 1 in 5 kids will ever even get a behavioral health diagnosis. And more shocking? Of those that are diagnosed, only 1 in 5 of those kids will ever even receive any care.

The supply-and-demand equation is off — stymied not only by a clinician shortage, but by literally poor reimbursement from health plans concerned about the lack of quality metrics, measurements, and processes in pediatric behavioral health despite the prevalence of those kinds of quality guidelines around adult mental health care.

So, how is Brightline going to fix this? Technology, clinicians, coaches. A full-stack clinical model with a “scaffolding” of support for parents built around it using telehealth, digital tools, and, for those health plans, metrics. Tune in to find out more about their business model, what Brightline’s kids are saying, and how you can find their services yourself if you think your child might need help.

Hear more from the ‘who’s who’ of health tech and health innovation as they work to make digital health, telehealth, data analytics, and virtual care a bigger part of the future of the healthcare industry.

Subscribe to WTF Health’s YouTube Channel: Follow Jess DaMassa on Twitter: Visit WTF Health:

Jessica DaMassa, the emerging ‘It girl’ of health tech interviewing, chats it up with the ‘who’s who’ of the health innovation set on ‘WTF Health – What’s the Future, Health?’ Catch 100’s of interviews with leading health tech startups and the VC investors, accelerators, health insurance companies, pharmas, and hospital systems helping bring their new ideas into the healthcare establishment. From AI and Big Data to virtual care, digital therapeutics, payment model innovation, health policy, and investing, Jessica helps you spot the trends and figure out what’s next.

To learn more about WTF Health, find out where Jess will be next, or throw some dollars at our show, check out

Sponsored by Bayer G4A, Livongo Health, GuideWell Innovation, Teladoc Health, OneDrop & The Health Care Blog

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Maca Root Benefits for Hormones, Fertility & More

I love using herbs and spices to support the body in healing itself. Maca root is a favorite because it’s so supportive of the body’s production of hormones. Since hormones rule a lot of the body’s processes, maca is a great natural supplement for female hormone support. Maca: A Root for Almost Anything Maca root …

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THCB’s Bookclub, September 2020 – NEO.LIFE


The THCB Book Club is a discussion with leading health care authors, which will be released on the third Wednesday of every month.

This month we hosted Jane Metcalfe (Founder of NEO.LIFE) to talk about her 2020 book NEO.LIFE. You can get a copy of it here!

NEO.LIFE is a very unusual book. It’s over 25 very short chapters (ranging from 1 page to 78) which include interviews, concepts, art, science, science fiction, and one short story. All from different authors or groups of authors that are all edited into place by Jane Metcalfe and Brian Bergstein.

The topic is the future of humans! And the loose focus is on biotech, human engineering, and well watch along and get a copy!

You can see the video below (and the podcast version will be in our iTunes & Spotify channels very soon).

In October the THCB BookClub will feature Mike Magee’s book, Code Blue.

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Hospitals Must Give Up Power to Save Healthcare


(This is the sixth in a series of excerpts from Terry’s new book, Physician-Led Healthcare Reform: a New Approach to Medicare for All, published by the American Association for Physician Leadership.)

As hospital systems become larger and employ more physicians, healthcare prices will continue to rise and independent doctors will find it harder to remain independent. Hospitals will never fully embrace value-based care as long as it threatens their primary business model, which is to fill beds and generate outpatient revenues. To create a viable, sustainable healthcare system, the market power of hospitals must be eliminated.

Federal antitrust policy is not adequate to handle this task. Even if the Federal Trade Commission had more latitude to deal with mergers among not-for-profit entities, the industry is already so consolidated that the FTC would have to break up health systems involving thousands of hospitals. Such a gargantuan effort would be practically and legally unfeasible.

All-payer Systems

 The government could curtail health systems’ market power without breaking them up. For example, either states or the federal government could adopt “all-payer” models similar to those in Maryland and West Virginia. Under the Maryland model introduced 40 years ago, every insurer, including Medicare, Medicaid, and private health plans, pays uniform hospital rates negotiated between the state and the hospitals.

It would be difficult for other states to replicate this approach because commercial rates are now so much higher than Medicare and Medicaid rates, said Paul Ginsburg, chair of the medicine and public policy department of the University of Southern California and a fellow of the Brookings Institution, in 2016 testimony to the California Senate Committee on Health. A more feasible approach, he said, would be to emulate West Virginia, which sets only commercial insurance payments to hospitals. In either case, however, an all-payer system would eliminate the ability of dominant health systems to extract very high rates from private payers.

Before Maryland implemented its all-payer model in 1977, the average cost of a Maryland hospital admission was 26% above the national average. In 2007, the average cost per case was 2% below the national average. However, in 2000, after the state eliminated payment adjustments based on the volume of hospital admissions, those admissions began to increase rapidly.Consequently, in 2014, Maryland started setting a global annual budget for each hospital in the state. Hospitals bill payers per admission (for inpatient care) or per service (for outpatient care) but are now expected to raise or lower their prices to remain on budget.

In the first three years after this program was fully implemented, Maryland hospital spending rose only 1.4% annually, well below the CMS target of 3.6%. Acute care admissions and gross hospital spending fell 2.7% and 2.3%, respectively, between fiscal years 2015 and 2016. Moreover, quality improved: Maryland saw a 6.1% reduction in readmissions and a 43.3% drop in hospital-acquired conditions over the three-year period.

As might be expected, providers responded to global budgets by shifting more care to the ambulatory and post-acute care sectors. Consequently, non-hospital spending in Maryland grew by 4.2% in 2016, greatly exceeding the national rate of 1.9% and offsetting the decrease in hospital spending.

Renewed Interest in States

 A few decades ago, several other states used all-payer rate setting, but they all abandoned it for various reasons. Most of these laws fell prey to gaming by providers and to political infighting within the states.Today, however, other states are following the path blazed by Maryland. In 2019, for example, Washington enacted a law under which the state will contract with private insurers to offer low-cost, tightly regulated plans on its ACA exchange. These plans will pay hospitals no more than 160% of Medicare rates. While this is much higher than the law’s proponents had hoped for, it was the best they could do to get the program enacted.

It’s unlikely that most states will go in this direction; however, the federal government could adopt a national all-payer rate system. Early in the transition to Medicare for All, Congress could pass legislation requiring all private insurers and self-insured employers to pay the same rates to hospitals, with adjustments for charity care and rural needs. Such rates would have to be negotiated by the government, which would continue to pay current Medicare rates; current state Medicaid rates would also remain in place until Medicaid was folded into Medicare during the transition period. Eventually, after private insurance disappeared, hospitals would be paid at negotiated rates across the board.

If the concept of a national all-payer system seems quixotic, no less an authority than Donald Berwick, MD, former acting administrator of CMS, recently proposed limiting hospital charges to 120% of Medicare rates across the board. “This is enough revenue to offset Medicaid underpayments and should provide appropriate pressure on hospitals to become more productive,” Berwick and Robert Kocher argued in a Health Affairs Blog post. The authors also recommended that future hospital price increases be limited to the annual increase in the consumer price index.7

Ginsburg supports the idea of unified administered pricing for hospitals. As quoted in my previous book, Rx For Health Care Reform, he noted that with universal coverage, states would no longer have to funnel money to inefficient hospitals to subsidize charity care. If all hospitals received the same risk-adjusted payments for the same procedures, he said, the inefficient ones would be likely to cut their costs or go out of business. On the other hand, he pointed out, the government would have to make allowances for special circumstances. For example, CMS would still have to subsidize teaching hospitals and trauma centers, he said.8

Hospitals must divest practices

Even under all-payer rate setting for hospitals, healthcare systems that employ a lot of physicians would still have bargaining power. To eliminate their ability to raise costs by negotiating higher rates for their employed physicians, the government could simply prohibit hospitals and other non-physician-owned entities from hiring doctors or owning their practices.

There are several good reasons for doing this. Besides raising costs, hospital employment of doctors can reduce the quality of care by forcing physicians to admit patients to lower-quality facilities. Hospital-owned practices have more preventable admissions than do physician-owned practices. In addition, burnout is more prevalent among employed physicians than among independent doctors because the former lament their loss of autonomy, notes Farzad Mostashari, CEO of Aledade and a former national coordinator of health IT.

The reluctance of healthcare systems to embrace value-based care must also be considered. Compared to independent practitioners, employed physicians have less incentive to restrain hospital utilization, so the divestment of owned practices would liberate physicians who are now “aligned” with hospital business strategies to pursue value-based care under a different set of financial incentives. Hospitals’ divestment of their practices is thus a cornerstone of the physician-led reform model I’m proposing.

Corporate Practice of Medicine Laws

Many states already have “corporate practice of medicine” laws that bar corporations from employing physicians. These statutes were enacted to avoid conflicts of interest between physicians’ duty to provide the best care for their patients and their employers’ dictates—exactly the kind of conflict in which many doctors find themselves today. Most states with such laws allow hospitals to hire doctors, however, since they’re also in the business of medicine.

The sole exception is California. That state’s corporate practice of medicine law prohibits any non-professional organization except for a public hospital, a narcotics treatment program, or a nonprofit medical research firm from directly employing physicians. Unfortunately, the California corporate practice of medicine law has not had the intended effect. Instead of hiring doctors, private hospitals and health systems simply lease their services from “foundations” that stand in for professional corporations.

The federal government could enact a stronger law that prohibits hospitals from directly or indirectly employing doctors. The statute should be written so that it also applies to insurance companies that employ doctors, such as United/Optum and Anthem. The venture capitalists that have recently been snapping up physician practices to turn them over for a profit should be forced to divest those practices as well.

It’s unclear how much it might cost the government to compensate insurers and private equity firms for divesting their practices. Optum’s recent $4.3 billion purchase of the giant DaVita Medical Group might be a marker for that expense; but however much it costs, corporations cannot be allowed to buy physician practices and use them for their own purposes. Healthcare is a public good, and its overriding goal must be to improve individual and population health.

Hospitals’ Objections

Hospitals would not have to be compensated for returning physicians to private practice. As noted earlier in this book, it’s unclear whether most hospitals would be worse off economically if their medical staffs were independent rather than employed. Considering the losses that hospitals incur on practice management, some hospitals would benefit financially from divesting their owned practices. The hospitals’ main concern, consultant Michael La Penna points out, would be to prevent competitors from controlling their referring doctors. If no health system could employ physicians, that wouldn’t be a problem.

Nevertheless, many hospitals would undoubtedly file lawsuits—or a class action suit—against the government. They might claim they were being unlawfully deprived of revenues that their employed physicians generated in excess of what those doctors would generate if they could refer to other hospitals, but this might be a hard case to make in court. Government attorneys would point out that hospitals cannot legally require employed doctors to refer to them. They could also observe that hospital employment of doctors has driven up health costs and, in some cases, resulted in inferior or unnecessary care.

The hospitals might also argue that they were being forced to divest their practices without compensation for their intrinsic value. Most hospital-owned practices, however, were acquired for little more than the value of their hard assets (equipment, fixtures, etc.) and receivables. Since most of these practices are losing money, it would be difficult to maintain that the hospitals should be compensated for giving them up.

Certain kinds of physicians should continue working for or exclusively contracting with hospitals because they are indispensable to inpatient or ED care. Among these are radiologists, pathologists, emergency department specialists, and critical-care physicians. Hospitals should also be allowed to employ hospitalists, who can increase the efficiency of care; however, at-risk physician groups should also have their own hospitalists. Hospitals would continue paying members of faculty practices for teaching and supervising residents, but the clinical practices of these physicians should also be divested.

Eliminating hospitals’ market power and prohibiting them from owning practices are only the beginning of the restructuring that physician-led healthcare reform would require. But these changes are the prerequisites for the new system, and nothing else is possible without them.

Ken Terry is a journalist and author who has covered health care for more than 25 years. He tweets @kenjterry.

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