Dan O'Neill

@dp_oneill

Healthcare tech, services and policy nerd. Health Policy Fellow at . Occasional writer. Amateur carpenter. All views are my own.

California, USA
Vrijeme pridruživanja: lipanj 2013.

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  1. Prikvačeni tweet
    12. kol 2019.

    In which California runs a 5-year experiment to test whether hospitals' private prices reflect "cost-shifting" to offset the burden of uncompensated care, and finds that.... ...Yeah...that's not a thing. Charity care↘️ Private prices ↗️ (dramatically) h/t

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  2. prije 13 sati

    Also a nice summary here - from the socialist nanny state of Texas - of the ways in which "patient choice" is a flaky, utterly unserious approach to surprise medical bills...

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  3. proslijedio/la je Tweet
    prije 20 sati

    How bout a handout to taxpayers and consumers?

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  4. proslijedio/la je Tweet
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  5. proslijedio/la je Tweet

    strikes again. From an emergency appendectomy to medical debt, this man's journey shows why Congress needs to take action to stop this predatory practice. Appendicitis Is Painful — Add A $41,212 Surgery Bill To The Misery via .

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  6. 30. sij

    If you’re wondering, Health charges $20 for a flu test, and Kaiser Permanente would, I think, charge somewhere around $60-70 in Northern California.

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  7. 30. sij

    Certainly looks like expects this patient to pay somewhere btwn 10 and 20 times what might be a reasonable price for an influenza test with a nasal swab. For perhaps 400,000 households in the Bay Area, this one bill would swallow ~10% of their annual income.

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  8. proslijedio/la je Tweet
    30. sij

    I am skeptical of M4A for a host of reasons, but “a mother of two young kids shouldn’t complain about thousands of dollars of penalties for switching jobs” is how conservatives lose the health care debate.

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  9. 30. sij

    👇👇 AMCs and hospital chains can be billion-dollar clients for EHR vendors. If data-sharing or easy API integration were hospital priorities, they would already be there. We need regulatory intervention because today’s health care “market” is pushing in the wrong direction.

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  10. proslijedio/la je Tweet
    29. sij

    The US ALREADY SPENDS ABOUT ENOUGH FOR SINGLE PAYER. And then, ON TOP OF THAT, has a whole OTHER, massively costly private healthcare system.

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  11. proslijedio/la je Tweet
    28. sij

    Most of us go into health care hoping to do well by doing right. But every health care business is a pivot away from doing well by harming people. Not said enough: health care leaders in search of a business model have a greater responsibility than other entrepreneurs.

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  12. 28. sij

    But whatever the pressure, ethics just have to win, so leadership matters. Some things are just wrong. True of surprise billing, extractive hospital collections, and Valeant-style abusive drug pricing. And it sure as hell is wrong to push addictive pills through an EHR. /n

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  13. 28. sij

    Another lesson probably speaks to early business model choices. It is harder to build a business focused on clinical quality or patient value than to milk the status quo. But once established, revenue models take on a life and logic of their own. Please choose carefully.

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  14. 28. sij

    Zoom out, and perhaps this is a reminder of the profound risk when an (overcapitalized?) startup is scrambling to make its number amidst the deeply conflicted - and often squarely unethical - financial practices that dot American healthcare.

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  15. 28. sij

    One way or another, it is difficult to even imagine the internal decision cycle that approved this work, without triggering ethical or legal alarm bells. In a $45 - 50M business, a $1M deal would presumably have been discussed at the Board level, at least in passing.

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  16. 28. sij

    And yet... Obviously Purdue paid for the program for a reason, and that reason almost certainly involved selling pills (I mean...c'mon). Most likely, nudging an MD to document pain boosts the propensity to prescribe pain pills. Just like those "talk to your doctor about X" ads.

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  17. 28. sij

    This was shared as research on decision support efficacy, in a legitimate forum, w/ clear acknowledgment of Purdue's involvement. And - at least in this case - the program does not seem to have explicitly nudged physicians to prescribe pain meds, only to document a pain score.

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  18. 28. sij

    We can get a bit of insight into what the opioid decision support campaign probably looked like - as with the vaccination program, it was apparently shared publicly at the time. In this case, as a poster at a 2017 AMIA conference. See 👇 (found on the public web)

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  19. 28. sij

    But then...applying this vaccination template to opioids is just an appalling, utterly inexcusable lapse in ethics and basic judgment. FWIW, I also don't think "hindsight" claims are an excuse - Sam Quinones's "Dreamland" came out in 2015, and Meier's "Pain Killer" years before.

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  20. 28. sij

    Still, reasonable people can disagree about this effort. Obviously, Merck funded the work to sell more vaccine doses. On the other hand, channeling pharma resources in this way can serve public health - there are similar "uptake" incentives in some Hep C treatment contracts.

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  21. 28. sij

    That's no small thing - pneumonia contributes to ~600K hospitalizations annually for Medicare patients, yet ~1/3 of those >65 have not been vaccinated. That campaign was reported at the time, in a largely positive light, and Merck's role was transparent:

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