Brian Klepper, PhD
Brian Klepper is a health care analyst.
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Latest articles
Drugs and prescribing
In 1736, Ben Franklin famously advised Philadelphians that preventing fires is better than fighting them. Mr. Franklin's advice is just as applicable today in addressing America's opioid crisis. Billions of opioid settlement dollars are being distributed to every state, and…
In 1736, Ben Franklin famously advised Philadelphians that preventing fires is better than fighting them. Mr. Franklin’s advice is just as applicable today in addressing America’s opioid crisis. Billions of opioid settlement dollars are being distributed to every state, and a portion of those funds should be allocated to preventing opioid addictions, not just buying fire extinguishers (Narcan) and fighting fires (medication-assisted therapy or substance use disorder treatment). Preventing opioid …
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Ben Franklin’s timeless wisdom: a key to solving America’s opioid crisis
Drugs and prescribing
A new study in JAMA Internal Medicine finds that two-thirds of cancer drugs considered by the U.S. Food and Drug Administration (FDA) over the past five years were approved without evidence that they improve health outcomes or length of life.…
A new study in JAMA Internal Medicine finds that two-thirds of cancer drugs considered by the U.S. Food and Drug Administration (FDA) over the past five years were approved without evidence that they improve health outcomes or length of life. (This study closely corroborates and acknowledges the findings published last year by John Fauber of the Milwaukee Journal Sentinel and Elbert Chu of MedPage Today.)
Follow-up …
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The FDA’s epic regulatory failure
Drugs and prescribing
Recently, the clinically positive results from the CLEOPATRA oncology trial were released, showing that pertuzumab, when added to docetaxel and trastuzumab as first-line chemotherapy, produces an average survival benefit of 15.7 months in HER2 positive breast cancer patients. That good…
Recently, the clinically positive results from the CLEOPATRA oncology trial were released, showing that pertuzumab, when added to docetaxel and trastuzumab as first-line chemotherapy, produces an average survival benefit of 15.7 months in HER2 positive breast cancer patients.
That good news notwithstanding, the authors calculated that Genentech’s price for adding pertuzumab to gain one quality adjusted life year is a breathtaking $713,219. In …
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Why reform needs to start at cancer care
Health policy
The catchy title of a recent Harvard Business Review Blog post, The Big Barrier To High Value Health Care: Destructive Self-Interest, suggested that the Institute for Healthcare Improvement (IHI) is forging arrangements that can overcome fee-for-service reimbursement’s propensity to drive…
The catchy title of a recent Harvard Business Review Blog post, The Big Barrier To High Value Health Care: Destructive Self-Interest, suggested that the Institute for Healthcare Improvement (IHI) is forging arrangements that can overcome fee-for-service reimbursement’s propensity to drive excess. As the honest broker, IHI could advocate for arrangements of mutual self-interest based on the right care, better outcomes and less money. Employers and unions would get lower costs, …
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Will fee for service ever go away?
Health policy
Recently I was asked to intervene on behalf of a patient who, trapped by circumstance, was paying off an enormous bill for a lithotripsy procedure. What I uncovered wasn’t news, but it drove home how egregious the current system can…
Recently I was asked to intervene on behalf of a patient who, trapped by circumstance, was paying off an enormous bill for a lithotripsy procedure. What I uncovered wasn’t news, but it drove home how egregious the current system can be, why it so badly needs to be fixed, and how the Affordable Care Act (ACA) helps move us in the right direction.
The patient had health insurance through her husband’s …
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Stop pursuing self-pay patients as a windfall opportunity
Health policy
A new class of health care management organization is emerging that thrives by taking advantage of health care’s rampant and institutionalized waste. These firms mine the market dysfunction that has developed over decades, which will almost certainly yield enough fuel…
A new class of health care management organization is emerging that thrives by taking advantage of health care’s rampant and institutionalized waste. These firms mine the market dysfunction that has developed over decades, which will almost certainly yield enough fuel to drive a new way to manage care and cost.
The founders of these organizations have deep health care experience, and they understand the mechanisms of excess. More important, the ones …
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Emerging enterprises of health care management
Health policy
With the recent release of two mainstream exposes, one in the Washington Post and another in the Washington Monthly, the American Medical Association’s (AMA) medical procedure valuation franchise, the Relative Value Scale Update Committee (RUC), has been exposed to the…
With the recent release of two mainstream exposes, one in the Washington Post and another in the Washington Monthly, the American Medical Association’s (AMA) medical procedure valuation franchise, the Relative Value Scale Update Committee (RUC), has been exposed to the light of public scrutiny. “Special Deal,” Haley Sweetland Edwards’ piece in the Monthly, provides by far the more detailed and lucid explanation of the mechanics of the RUC’s arrangement with …
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Why the Accuracy In Medicare Physician Payment Act should pass
Health policy
Several physicians have reached out recently to discuss attractive employment offers from health systems. They are invariably conflicted. They understand the trade-offs, that they’ll give up the autonomy they’ve become accustomed to in exchange for more money and fewer practice…
Several physicians have reached out recently to discuss attractive employment offers from health systems. They are invariably conflicted. They understand the trade-offs, that they’ll give up the autonomy they’ve become accustomed to in exchange for more money and fewer practice management headaches. On the down side, they’ll be accountable for generating significant revenues, sometimes independent of care appropriateness.
Most also are aware that the same care services they provide now will …
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A brave new world as more physicians become employed
Health policy
What is the path forward for physicians who want to remain in private practice, outside the constraints of health system employment? How will the environment change and what new demands will that place on practices and physicians? What follows are…
What is the path forward for physicians who want to remain in private practice, outside the constraints of health system employment? How will the environment change and what new demands will that place on practices and physicians? What follows are the observations of one industry-watcher who has worked on all sides of health care, but who now spends most his time focused on the interests of those who pay for …
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The path for physicians who want to remain in private practice
Health policy
For a large and growing number of us with meager or no coverage, health care is the ultimate “gotcha.” Events conspire, we receive care and then are on the hook for a car- or house-sized bill. There are few alternatives…
For a large and growing number of us with meager or no coverage, health care is the ultimate “gotcha.” Events conspire, we receive care and then are on the hook for a car- or house-sized bill. There are few alternatives except going without or going broke.
Steven Brill’s recent cover story clearly detailed the predatory health care pricing that has been ruinous for many rank-and-file Americans. In Brill’s report, a key mechanism, …
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America’s health system is dangerously out of balance
Health policy
On January 7, 2013, a federal appeals court rejected six Georgia primary care physicians’ (PCPs) challenge to the Centers for Medicare and Medicaid Services’ (CMS) 20-year, sole-source relationship with the secretive, specialist-dominated federal advisory committee that determines the relative value…
On January 7, 2013, a federal appeals court rejected six Georgia primary care physicians’ (PCPs) challenge to the Centers for Medicare and Medicaid Services’ (CMS) 20-year, sole-source relationship with the secretive, specialist-dominated federal advisory committee that determines the relative value of medical services. The American Medical Association’s (AMA) Relative Value Scale Update Committee (RUC) is, in the court’s view, not subject to …
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The RUC survives and now our health system is worse off
Health policy
How many businesses do you know that want to cut their revenue in half? That’s why the healthcare system won’t change the healthcare system. -Rick Scott, Governor of Florida Former CEO, Hospital Corporation of America The Washington Post recently reported…
How many businesses do you know that want to cut their revenue in half? That’s why the healthcare system won’t change the healthcare system.
-Rick Scott, Governor of Florida
Former CEO, Hospital Corporation of America
The Washington Post recently reported that health plan lobbyists, charts at the ready, are working to convince legislators that unreasonable health care costs are everyone else’s fault. Karen Ignagni, the Executive Director of America’s Health Insurance Plans (AHIP) declared: “If you’re …
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Health plans need to take more responsibility for rising costs
Health technology
My wife Elaine was hospitalized for 6 days recently with an array of ailments related to her advancing cancer, so diagnosing and addressing her problems required a multidisciplinary approach. In addition to the nursing and support staffs, she was tended…
My wife Elaine was hospitalized for 6 days recently with an array of ailments related to her advancing cancer, so diagnosing and addressing her problems required a multidisciplinary approach. In addition to the nursing and support staffs, she was tended by an emergency physician, two hospitalists, three gastroenterologists, a pulmonologist, an infectious disease physician and an interventional radiologist. With the exception of one specialist who had performed a procedure on …
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Health information exchange is the foundation of care coordination
Health policy
Veteran analyst Vince Kuraitis recently reviewed a report from the consulting firm Oliver Wyman (OW), arguing that the trend toward reconfiguring health systems to deliver more accountable care is more widespread than any of us suspect: The healthcare world has…
Veteran analyst Vince Kuraitis recently reviewed a report from the consulting firm Oliver Wyman (OW), arguing that the trend toward reconfiguring health systems to deliver more accountable care is more widespread than any of us suspect:
The healthcare world has only gotten serious about accountable care organizations in the past two years, but it is already clear that they are well positioned to provide a serious competitive threat to traditional fee-for-service medicine. In
…
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Most ACOs are accountable in name only
Health policy
At our first meeting years ago, Tom Emerick, Walmart's then VP of Global Benefits, told me, "No industry can grow continuously at a multiple of general inflation. It will eventually become so expensive that purchasers will simply abandon it." He…
At our first meeting years ago, Tom Emerick, Walmart’s then VP of Global Benefits, told me, “No industry can grow continuously at a multiple of general inflation. It will eventually become so expensive that purchasers will simply abandon it.”
He said it casually, as though it was obvious and indisputable.
Health care is playing out this way. From 1999 to 2011, health care premium inflation grew steadily at 4 times the general inflation rate. During …
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A new organizational structure is coming in health care
Health policy
Walmart's sheer size makes almost any of their initiatives newsworthy. That said, despite being a lightning rod for criticism on employee benefits and health care, they have introduced initiatives with far-reaching impacts. Their generic drug program began in September 2006…
Walmart’s sheer size makes almost any of their initiatives newsworthy. That said, despite being a lightning rod for criticism on employee benefits and health care, they have introduced initiatives with far-reaching impacts. Their generic drug program began in September 2006 – more than 300 prescription drugs for $4/month or $10 for a 90-day supply – and was widely emulated, disrupting retail drug markets and generating immense social benefit. Imagine the …
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Walmart’s Center of Excellence program is another innovation
Health policy
The American Academy of Family Physicians (AAFP) recently issued a new report describing its vision of primary care's future. Not surprisingly, the report talks about medical homes, with patient-centered, team-based care. More surprisingly, though, it makes a point to insist…
The American Academy of Family Physicians (AAFP) recently issued a new report describing its vision of primary care’s future. Not surprisingly, the report talks about medical homes, with patient-centered, team-based care.
More surprisingly, though, it makes a point to insist that physicians, not nurse practitioners, should lead primary care practices. The important questions are whether nurse practitioners are qualified to …
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The AAFP picks a fight with nurse practitioners
Health policy
Excessive health care spending is overwhelming America’s economy, but the subtler truth is that this excess has been largely facilitated by subjugating primary care. A wealth of evidence shows that empowered primary care results in better outcomes at lower cost.…
Excessive health care spending is overwhelming America’s economy, but the subtler truth is that this excess has been largely facilitated by subjugating primary care. A wealth of evidence shows that empowered primary care results in better outcomes at lower cost. Other developed nations have heeded this truth. But US payment policy has undervalued primary care while favoring specialists. The result has been spotty health quality, with costs that are double …
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Diminishing primary care leads to excessive health spending
Health policy
Several years ago I had dinner with a woman who had served in the late 1990s as the national Chief Medical Officer of a major health plan. At the time, she said, she had developed a strategic initiative that called…
Several years ago I had dinner with a woman who had served in the late 1990s as the national Chief Medical Officer of a major health plan. At the time, she said, she had developed a strategic initiative that called for abandoning the plan’s utilization review and medical management efforts, which had produced heartburn and a backlash among both physicians and patients. Instead, the idea was to retrospectively analyze utilization …
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Why medical management is critical to health reform
Patient voices
The news of my wife Elaine’s primary peritoneal cancer 27 months ago began a fevered effort to learn all we could about her disease and our options. Peritoneal cancer, which is close in form and behavior to ovarian, is rooted…
The news of my wife Elaine’s primary peritoneal cancer 27 months ago began a fevered effort to learn all we could about her disease and our options. Peritoneal cancer, which is close in form and behavior to ovarian, is rooted in the abdominal lining. “Gold standard” treatments notwithstanding, the prognosis isn’t good. After a 12-36 month remission in which tumors are inactive, the disease generally returns, and a high percentage …
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Genomic medicine: How it can help cancer patients
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