Waste, Fraud and Abuse – Oh, My!

By KIM BELLARD So the House has passed their “big, beautiful bill,” by the narrowest of margins. Crucial to the bill are large savings from Medicaid, which in past years Republicans would have taken some glee from but now they are careful to explain away as just cutting “waste, fraud and abuse,” having finally realized…

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Factors That Increase Utilization Management Risk

That is the title of a new paper published in the American Journal of Managed Care (AJMC) with co-authors Jacob Fajnor, Shurui Zhang, and Donald Nichols. The abstract is below. Objectives: To (1) develop a metric that quantitatively measures the risk that utilization management (UM) policies pose to patients and (2) measure the relationship between…

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An Arm and a Leg: A Mathematical Solution for US Hospitals?

What do the KGB and the former CEO of Cincinnati Children’s Hospital have in common? Eugene Litvak. The Soviet intelligence agency and the children’s hospital have each separately looked to the Ukrainian émigré with a PhD in mathematics for help. He turned down the KGB, but Litvak saved Cincinnati Children’s Hospital more than $100 million…

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The Crawfish Chronicles: An NIH Fixed Cost Cap Parable

By GREGROY HOPSON T-Maître Pierre’s Family Restaurant was a Louisiana institution. The kind of place where generations gathered over steaming mountains of boiled crawfish, spicy corn, and seasoned potatoes. A place where Clifton Chenier’s Louisiana Blues & Zydeco played in the background and the waitstaff wore starched white shirts with bright-colored bow ties. The walls…

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