Tag: COVID-19

Fortune Magazine quotes David Williams on vaccine mandates

September 21st, 2021 by

A Kaiser Family Foundation report revealed the impact of the unvaccinated on the US health care system $5.7 billion. Fortune (Unvaccinated Americans cost the health system $5.7 billion) quotes David Williams on the impact of mandates and why busy hospitals are losing money.

“Because it’s so political, this takes the heat off of employers to mandate vaccines,” said David E. Williams, president of Boston-based Health Business Group, a health care consulting firm. He thinks mandates will make a difference in hospitalizations.“Each incremental percentage in vaccination is valuable to the country as a whole.”

More than half of U.S. hospitals closed the fourth quarter of 2020 with negative margins, and half a dozen filed for bankruptcy. “They had a lot of customers,” Williams said, “but the wrong kind.”

Interview with Affinity Empowering’s Michael Tkach

August 5th, 2021 by

Michael Tkach Headshot Affinity Empowering
Dr. Michael Tkach

Affinity Empowering Chief Behavioral Health Officer and Chief Operating Officer Dr. Michael Tkach grew up reading Sherlock Holmes and sniffing out the perpetrator of an ice shack arson. By now he’s graduated to studying the linkage between inflammation and depression while pioneering a streamlined and powerful approach to pool testing for COVID-19. Two swabs anyone?

Interested organizations can enroll for the program online.

In this episode of the HealthBiz podcast, Michael shares insights on using the psychology of the news media to understand human behavior during the pandemic, and tells us whether Affinity is a tech company in health care or a health company in technology.

The HealthBiz podcast is available on SpotifyApple PodcastsGoogle PodcastsYouTube and  many more services. Please consider rating the podcast on Apple Podcasts.


By healthcare business consultant David E. Williams, president of Health Business Group.

Vaccine reimbursement is equal across providers and insurers. What if we did the same for all care?

April 5th, 2021 by
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What adjustments are needed?

A seemingly straightforward story caught my eye last week: all Massachusetts providers are being paid the same, generous fee for COVID-19 vaccine administration (Boston Globe). The fee is essentially identical whether the patient has Medicaid, Medicare, commercial insurance –or no insurance. And it doesn’t matter whether the shot is given in a pharmacy, clinic, community hospital, or academic medical center.

It seems logical and makes intuitive sense to the average consumer. But for those in the healthcare field, it’s pretty radical! After all, reimbursement rates for commercially insured patients are usually a multiple of what Medicaid pays and substantially higher than Medicare. And providers and insurers exert extreme efforts negotiating rates (and then trying to keep them secret). Some providers use their market power to drive harder bargains, and insurers do the same.

Bottom line: Reimbursement rates are all over the map, varying wildly depending on who’s the provider and who’s paying. A 2020 Health Care Cost Institute study provides some detail.

This reality has shaped and distorted the US healthcare system:

  • Providers avoid Medicaid patients to cherry pick those with commercial coverage
  • The true cost of Medicaid (and to a lesser extent, Medicare) is obscured by cross-patient subsidies
  • Providers use their market power to extract higher rates, and generate reimbursement ‘synergies’ by acquiring providers with weaker negotiating positions or reclassifying  physician offices as hospital ‘facilities’ that generate their own upcharges
  • Patients get treated in settings that maximize providers’ margins rather than where it’s best for the patients
  • Health plans merge to bulk up against provider systems
  • Health disparities are exacerbated as poorer patients are worth less to providers and get lower priority
  • Tremendous administrative costs are expended to manage the complexity, exploit the rules and search for those who are bending or breaking them

It’s tempting to think we could reform healthcare payment by using this COVID-19 vaccine approach for all reimbursement. But the vaccine is a special case, because there is a specific, national objective to get as many people vaccinated as quickly as possible to end the pandemic and because vaccine administration is pretty simple. Lots of providers are capable of it, and there are unlikely to be differences in outcomes based on provider experience or setting. Across the political spectrum, there is genuine agreement that we want everyone –including poor people and immigrants regardless of status– to get a shot or even two. And we’re happy for providers to prioritize vaccination by allowing them to make good money doing it.

Those conditions don’t hold generally in healthcare. Still, I am in favor of policies that encourage or mandate reducing the gaps in what providers are paid for the same service. There should be a convergence between Medicaid, Medicare and commercial rates, and reimbursement should not vary so dramatically by provider or setting of care.

New approaches, like alternative payment models, often bake in the fee-for-service biases. They shouldn’t.


By healthcare business consultant David E. Williams, president of Health Business Group.

How vaccine success and fourth surge are connected. David Williams in the Boston Globe

March 31st, 2021 by

It’s counterintuitive: a fourth covid-19 wave is evident even as vaccine rollout accelerates. Conventional wisdom blames it on more contagious variants, pandemic fatigue, and states reopening too fast. There’s truth to all of that, but it overlooks the role that vaccination itself plays.

David Williams shared his thinking with the Boston Globe (CDC Director Walesnsky stresses ‘hope,’ not ‘doom,’ after touring Hynes Convention Center. Vaccinations are accelerating even as COVID-19 cases also rise.)

“As spring comes, people in their 20s are relaxing their behavior and going out to restaurants with their friends,” said David Williams, president of Health Business Group, a Boston management consulting firm. “They don’t have to feel as guilty about infecting them if Ma and Grandma have already been vaccinated.”

Now that the old are vaccinated, we need to make sure young adult vaccination is quickly ramped up. There should be plenty of vaccine available shortly to do so.

“This is the time when we’re going from scarcity to surplus,” said Williams of the Health Business Group. “People who are eligible are now getting appointments, even if they have to work a bit, and a lot more people are now eligible. It still feels tight. But in the next two to three weeks, instead of waking up at 1 in the morning to book an appointment, you should be able to do at 2 in the afternoon.”

 

How the new surge and vaccine success are connected

March 31st, 2021 by
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Catch a wave and you’re sitting on top of the surge

It’s counterintuitive: a fourth covid-19 wave is evident even as vaccine rollout accelerates. Conventional wisdom blames it on more contagious variants, pandemic fatigue, and states reopening too fast. There’s truth to all of that, but it overlooks the role that vaccination itself plays.

I shared my thinking with the Boston Globe (CDC Director Walesnsky stresses ‘hope,’ not ‘doom,’ after touring Hynes Convention Center. Vaccinations are accelerating even as COVID-19 cases also rise.)

“As spring comes, people in their 20s are relaxing their behavior and going out to restaurants with their friends,” said David Williams, president of Health Business Group, a Boston management consulting firm. “They don’t have to feel as guilty about infecting them if Ma and Grandma have already been vaccinated.”

It’s actually pretty straightforward. We’ve asked younger people to make severe sacrifices over the past year. A central argument has been that they are protecting their older relatives and others in society, who are at mortal risk if infected. Now that the old are largely protected through vaccination, the argument loses its logic.

Vaccine rollout priority has focused on reducing death and hospitalization. That’s why we started with the elderly. If we wanted to reduce the number of infections, we would have started with the young.

Now that the old are vaccinated, we need to make sure young adult vaccination is quickly ramped up. There should be plenty of vaccine available shortly to do so.

“This is the time when we’re going from scarcity to surplus,” said Williams of the Health Business Group. “People who are eligible are now getting appointments, even if they have to work a bit, and a lot more people are now eligible. It still feels tight. But in the next two to three weeks, instead of waking up at 1 in the morning to book an appointment, you should be able to do at 2 in the afternoon.”

Today’s news that the Pfizer vaccine seems to work well in kids and not pose safety concerns is also great news. We should vaccinate the whole population by summer if at all possible.

Image by Manie Van der Hoven from Pixabay


By healthcare business consultant David E. Williams, president of Health Business Group.