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• Article | Health Affairs Blog | June 30, 2020

  Bipartisan Tax-Free Solution to Health Care Financing: Coupling HRAs With a Public Option

  Regina E. Herzlinger, Richard Boxer and James Wallace

  A combination of health insurance initiatives by the presumptive 2020 Democratic and Republican presidential nominees could expand health care coverage and significantly reduce costs, without raising taxes. Along the way, the combination could revitalize private insurance plans’ competition. One initiative, proposed by former Democratic Vice President Joseph Biden, requires a Public Option so non-seniors can enroll in Medicare. The other initiative is President Donald Trump’s rule that enables employees in small and medium sized enterprises (SMEs) to use pre-tax funds, which their employers deposit in Individual Coverage Health Reimbursement Arrangements (ICHRAs). Under this HRA-Public Option combination, the employee could buy a suitable ACA plan that would be administered by private insurers ,paying Medicare’s rates, with its substantial economies. In addition, if the Public Option-HRA combination were priced to reduce Medicare‘s unfunded liabilities, its price would remain lower than Obamacare or those paid by SME enrollees. Simultaneously, combining HRAs with the Public Option would spur private health insurers to compete by using their massive scale to reduce the bloated U.S. health care system. They could compete by reducing the estimated waste in the health care system of $900 billion; experts estimate that at least 250 billion could be saved without diminishing the quality of care.

  Keywords: health care financing; Public Option; health reimbursement arrangement (HRA); Health Care and Treatment; Insurance; Cost Management;

  Citation:

  Herzlinger, Regina E., Richard Boxer, and James Wallace. "Bipartisan Tax-Free Solution to Health Care Financing: Coupling HRAs With a Public Option." Health Affairs Blog (June 30, 2020).  View Details

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• Article | Annals of Emergency Medicine

  The Inpatient Discharge Lounge as a Potential Mechanism to Mitigate Emergency Department Boarding and Crowding

  Brian Franklin, Sharif Vakili, Robert S. Huckman, Sarah Hosein, Nicholas Falk, Katherine Cheng, Maria Murray, Sheila Harris, Charles A. Morris and Eric Goralnick

  Delayed access to inpatient beds for admitted patients contributes significantly to emergency department (ED) boarding and crowding, which have been associated with deleterious patient safety effects. To expedite inpatient bed availability, some hospitals have implemented discharge lounges, allowing discharged patients to depart their inpatient rooms while awaiting completion of the discharge process or transportation. This conceptual article synthesizes the evidence related to discharge lounge implementation practices and outcomes. Using a conceptual synthesis approach, we reviewed the medical and gray literature related to discharge lounges by querying PubMed, Google Scholar, and Google and undertaking backward reference searching. We screened for articles either providing detailed accounts of discharge lounge implementations or offering conceptual analysis on the subject. Most of the evidence we identified was in the gray literature, with only three peer-reviewed articles focusing on discharge lounge implementations. Articles generally encompassed single-site descriptive case studies or expert opinions. Significant heterogeneity exists in discharge lounge objectives, features, and apparent influence on patient flow. Although common barriers to discharge lounge performance have been documented, including underuse and care team objections, limited generalizable solutions are offered. Overall, discharge lounges are widely endorsed as a mechanism to accelerate access to inpatient beds, yet the limited available evidence indicates wide variation in design and performance. Further rigorous investigation is required to identify the circumstances under which discharge lounges should be deployed as well as how discharge lounges should be designed to maximize their effect on hospitalwide patient flow, ED boarding and crowding, and other targeted outcomes.

  Keywords: health care delivery; emergency room; operations improvement; operations management; Health Care and Treatment; Service Delivery; Operations; Management; Performance Improvement; Service Operations;

  Citation:

  Franklin, Brian, Sharif Vakili, Robert S. Huckman, Sarah Hosein, Nicholas Falk, Katherine Cheng, Maria Murray, Sheila Harris, Charles A. Morris, and Eric Goralnick. "The Inpatient Discharge Lounge as a Potential Mechanism to Mitigate Emergency Department Boarding and Crowding." Annals of Emergency Medicine 75, no. 6 (June 2020): 704–714.  View Details

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• Article | JAMA, the Journal of the American Medical Association

  The Business of Medicine in the Era of COVID-19

  David M. Cutler, Sayeh Nikpay and Robert S. Huckman

  This Viewpoint discusses the shifting landscape of health care financing, regulation, and delivery as a result of the coronavirus pandemic, and discusses regulatory and other changes that need to be in place if telehealth and physician practice and hospital mergers become the “new normal” once the pandemic is controlled.

  Keywords: health care; COVID-19; telemedicine; business; Health Pandemics; Health Care and Treatment; Change; Competition;

  Citation:

  Cutler, David M., Sayeh Nikpay, and Robert S. Huckman. "The Business of Medicine in the Era of COVID-19." JAMA, the Journal of the American Medical Association 323, no. 20 (May 26, 2020): 2003–2004.  View Details

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