Ezekiel J. Emanuel

You are viewing 62 posts in the category Academic Writing

Apr 5

Next Phase in Effective Cost Control in Health Care

Glickman A, DiMagno SSP, Emanuel EJ.

JAMA, March 2019.

Read this article.

Categories: Academic Writing

Apr 5

Effect of Financial Bonus Size, Loss Aversion, and Increased Social Pressure on Physician Pay-For-Performance: A Randomized Clinical Trial and Cohort Study

Navathe AS, Volpp KG, Caldarella KL, Bond A, Troxel AB, Zhu J, Matloubieh S, Lyon Z, Mishra A, Sacks L, Nelson C, Patel P, Shea J, Calcagno D, Vittore S, Sokol K, Weng K, McDowald N, Crawford P, Small D, Emanuel EJ. 

JAMA Network, February 2019.

Read this article.

Categories: Academic Writing

Apr 5

National Representativeness of Hospitals and Markets in Medicare's Mandatory Bundled Payment Program

Liao JM, Emanuel EJ, Polsky DE, Huang Q, Shah Y, Zhu J, Lyon ZM, Dykstra SE, Dinh CT, Counsins DS, Navathe AS. 

Health Affairs, January 2019.

Read this article.

Categories: Academic Writing

Apr 5

Pricing a Year of Progression-Free Survival: When is the Cost of Cancer Drugs Unreasonable?

DiMagno SSP, Emanuel EJ.

JAMA Dermatology, December 2018.

Read this article.

Categories: Opinions , Academic Writing

Apr 5

Pitfalls and Potential in Medicare's Move Toward Outpatient Care Episodes

Navathe AS, Emanuel EJ, Liao JM.

Annals of Internal Medicine, December 2018.

Read this article.

Categories: Academic Writing

Apr 5

Outcomes for Individuals Turned Down for Living Kidney Donation

Reese PP, Allen MB, Carney C, Leidy D, Levsky S, Pendse R, Mussell AS, Bermudez F, Keddem S, Thiessen C, Rodrigue JR, Emanuel EJ. 

Clinical Transplantation, December 2018.

Read this article.

Categories: Academic Writing
Tags: Health Care

Apr 5

Aligning Patient and Physician Incentives

Navathe AS, Emanuel EJ, Volpp KG.

JAMA, October 2018.

Read this article. 

Categories: Academic Writing
Tags: Health Care

Apr 5

Association of Hospital Participation in a Medicare Bundled Payment Program with Volume and Case Mix of Lower Extremity Joint Replacement Episodes

Navathe AS, Liao JM, Dykstra SE, Wang E, Lyon ZM, Shah Y, Martinez J, Small DS, Werner RM, Dinh C, Ma X, Emanuel EJ. 

JAMA, September 2018.

Read this article. 

Categories: Academic Writing

Apr 5

Brain Leaks and Consumer Neurotechnology

Ienca M, Haselager P, Emanuel EJ. 

Nature Biotechnology, September 2018. 

Read this article. 

Categories: Academic Writing

Mar 29

The Status of End-of-Life Care in the United States: The Glass is Half Full

JAMA, July 2018.

Read this article.

Categories: Academic Writing

Mar 29

Redesigning Provider Payment: Opportunities and Challenges From the Hawaii Experience

Volpp KG, Navathe AS, Lee EO, Mugishii M, Troxel AB, Caldarella K, Hodlofski A, Bernheim S, Drye E, Yoshimoto J, Takata K, Stollar MB, Emanuel EJ.

Healthcare (Amsterdam, Netherlands), September 2018.

Read the article. 

    Abstract

    Objectives

    To describe the process of developing a new physician payment system based on value and transitioning away from a fee-for-service payment system

    Study design

    Descriptive. This paper describes a recent initiative involving redesign of primary care provider payment in the State of Hawaii. While there has been extensive discussion about switching payment from volume to value in recent years, much of this change has happened at the organizational level and this initiative focused on changing the incentives for individual providers.

    Methods

    Descriptive paper. In this paper we discuss the approach taken to shift incentives from fee-for-service towards value using behavioral economics as a conceptual framework for program design. We summarize the new payment system, challenges in its design, and our approach to piloting of different behavioral economic strategies to improve performance.

    Results

    None.

    Conclusions

    This paper will provide useful guidance to health plans or health delivery systems considering shifting primary care payment away from fee-for-service towards value highlighting some of the design challenges and necessary compromises in implementing such a system at scale.

     
    Categories: Academic Writing

    Mar 27

    Physician Practice Variation Under Orthopedic Bundled Payment

    Liao JM, Emanuel EJ, Whittington GL, Small DS, Troxel AB, Zhu J, Zhong W, Navathe AS. 

    American Journal of Managed Care, June 2018.

    Read this article. 

    ABSTRACT 

    Objectives: To describe the extent of and longitudinal changes in physician practice variation with respect to implant costs, institutional postacute care (PAC) provider utilization, and total episode payments, as well as to evaluate the association between physician volume and quality and these outcomes.

    Study Design: Observational study.

    Methods: We combined claims and internal hospital cost data for 34 physicians responsible for 3614 joint replacement episodes under bundled payment at Baptist Health System (BHS). Multilevel multivariable generalized linear models were employed and the intraclass correlation (ICC) was used to quantify between-physician variation.

    Results: There was significant between-physician variation in implant costs, institutional PAC provider utilization, and total episode payments not explained by observable variables (<.001 for all). Over 5 years, the ICC decreased from 0.26 to 0.06, 0.15 to 0.13, and 0.12 to 0.10 for implant costs, institutional PAC provider utilization, and total episode payments, respectively, but differences were not statistically significant. Both higher physician case volume and quality were associated with decreased total episode payments and institutional PAC provider utilization, but not with changes in implant costs.

    Conclusions: Considerable physician practice variation was observed under bundled payment at BHS and decreased to a greater degree for implant costs than institutional PAC provider utilization or total episode payments. Institutional PAC provider utilization and total episode payments were associated with physician volume and quality. Although some organizational strategies achieve gains by reducing physician practice variation, variation reduction is not an absolute requisite for success under bundled payment.

    Categories: Academic Writing

    Mar 27

    Comparison of Hospitals Participating in Medicare's Voluntary and Mandatory Orthopedic Bundle Programs

    Navathe AS, Liao JM, Polsky D, Shah Y, Huang Q, Zhu J, Lyon ZM, Wang R, Rolnick J, Martinez JR, Emanuel EJ. 

    Health Affairs June 2018.

    Read this article.

    ABSTRACT

    We analyzed data from Medicare and the American Hospital Association Annual Survey to compare characteristics and baseline performance among hospitals in Medicare’s voluntary (Bundled Payments for Care Improvement initiative, or BPCI) and mandatory (Comprehensive Care for Joint Replacement Model, or CJR) joint replacement bundled payment programs. BPCI hospitals had higher mean patient volume and were larger and more teaching intensive than were CJR hospitals, but the two groups had similar risk exposure and baseline episode quality and cost. BPCI hospitals also had higher cost attributable to institutional postacute care, largely driven by inpatient rehabilitation facility cost. These findings suggest that while both voluntary and mandatory approaches can play a role in engaging hospitals in bundled payment, mandatory programs can produce more robust, generalizable evidence. Either mandatory or additional targeted voluntary programs may be required to engage more hospitals in bundled payment programs.

    Categories: Academic Writing

    Mar 12

    Incorporating Value Into Physician Payment and Patient Cost Sharing

    Song Z, Navathe AS, Emanuel EJ, Volpp KG. 

    American Journal of Managed Care, March 2018. 

    Read this article. 

    ABSTRACT: 

    The United States is simultaneously moving toward value-based payments for populations and precision medicine for individuals. During this evolution, innovations in payment and delivery that enhance tailoring of treatments to individuals while improving the value of care are needed. We propose one such innovation that would allow physician payment and patient cost sharing to better reflect the value of care by allowing the appropriateness of a service for a given patient in a given clinical situation to play a more meaningful role in the design of such incentives. We introduce the idea of a payment modifier, based on indication and appropriateness, and discuss its advantages and challenges to implementation.

    Categories: Academic Writing

    Mar 12

    The Real Cost of the US Health Care System


    Mar 12

    Characteristics of Hospitals Earning Savings in the First Year of Mandatory Bundled Payment for Hip and Knee Surgery

    Navathe AS, Liao JM, Shah Y, Lyon Z, Chatterjee P, Polsky D, Emanuel EJ. 

    JAMA, March 2018.

    Read this article. 

    Categories: Academic Writing

    Mar 12

    Does Medicine Overemphasize IQ?

    Emanuel EJ, Gudbransen E. 

    JAMA, February 2018. 

    Read this article. 

    In this Viewpoint, Ezekiel Emanuel argues that emotional intelligence (EQ) is as important as IQ for the effective practice of medicine and calls for medical schools to evaluate the EQ of applicants and provide opportunities to enhance EQ among medical students.

    Categories: Academic Writing

    Mar 12

    Volume Increases and Shared Decision-making in Joint Replacement Bundles

    Navathe AS, Liao SM, Emanuel EJ. 

    Annals of Surgery, January 2018.

    Read this article

    Categories: Academic Writing

    Mar 12

    Reforming American Medical Education

    The Milbank Quarterly, December 2017

    Read this article

    Categories: Academic Writing
    Tags: Health Care

    Mar 12

    Measuring the Burden of Health Care Costs on US Families: The Affordable Index

    Emanuel EJ, Glickman A, Johnson D. 

    JAMA, November 2017

    Read this article


    This Viewpoint proposes a new Affordability Index measure, the ratio of the mean cost of an employer-sponsored family health insurance policy divided by median household income, to describe US families’ ability to pay for health care.

    Categories: Academic Writing