Dr. Niran Al-Agba

Building Better Metrics: Immunizations and Asking the Right Question

Washington State Law allows vaccine exemptions on the basis of religious, philosophical, or personal reasons; therefore, immunizations rates are considerably lower (85%) compared to states where exemptions rules are tighter. Immunization rates are directly proportional to the narrow scope of state vaccine exemptions laws. Immunization rates are used to “rate” the primary care physician despite the fact we have little influence on the outcome according to scientific studies.

Niran Al-Agba2020-05-14T04:07:02+00:00October 10, 2017|Categories: Physician, Policy|Tags: ACA, Affordable Care, Health Policy, Immunizations, Metrics, Vaccine, Value-based Care|

As Ohio Goes, So May the Nation: The Patient Access Expansion Act

The American Board of Medical Specialties (ABMS) eliminated “lifetime” certification to shore up their financial outlook; a modification having little to do with quality and much to do with rate of return. Between 2003 and 2013, the ABMS member boards’ assets ballooned from $237 million to a staggering $635 million, an annual growth rate of 10.4%. MOC is outrageously lucrative. Almost 88% of their revenue came from certification fees.

Niran Al-Agba2020-05-14T04:05:26+00:00September 26, 2017|Categories: Patient, Policy|Tags: Affordable Care, Anti-MOC, Hospitals, MOC, Patient Physician Relationship, Rural Care, Underserved|

Musings on a Micro-Hospital for the City of Bremerton

The idea of micro-hospitals is gaining traction because costs of construction are far lower than that of more traditional hospital facilities –costing anywhere between $7-$30 million, depending on the range of services available, according to Advisory Board statistics. Micro-hospitals can meet 90% of the community healthcare needs. They seem to flourish best in markets with critical service gaps. Ideally, micro-hospitals are located within 20 miles of a full-service hospital, facilitating the transfer of patients to larger facilities if higher-acuity needs arise. Hospital stays anticipated to be longer than 48 hours are sent to higher-acuity facilities.

Niran Al-Agba2020-05-14T04:04:04+00:00September 22, 2017|Categories: Patient, Policy|Tags: ACA, Affordable Care, CHI, Consolidation, Corporatization, Dignity, Franciscan, Hospitals, Microhospital, Surprise Billing|

Is It Time for Physicians to Unionize?

Since the birth of our nation, labor unions have existed in one form or another in the United States. Unions are a force to protect the ‘working population’ from inequality, gaps in wages, and a political system failing to represent specific industry groups. The existence of unions has already been woven into the political, economic, and cultural fabric of America; it may be time for physicians and surgeons to unionize.

Niran Al-Agba2020-05-14T04:03:09+00:00September 19, 2017|Categories: Physician, Policy|Tags: ACA, Affordable Care, Corporatization, Labor Union, Physician Autonomy, Physician Union, Unionization, United Physicians|

Hold the Mayo and Save Our Hospital

There is a grassroots movement, 4500 strong, known as “Save Our Hospital” gaining notoriety in Albert Lea, Minnesota. This story is symptomatic of the fact that hospital consolidation has slowly become a national pastime. With declining revenue under the Affordable Care Act, mergers increased by 70%, leaving small communities scrambling for healthcare access. The latest casualty in the ‘hospital-consolidation-for-sport’ trend is Albert Lea, a small city located in Freeborn County, Minnesota.

Niran Al-Agba2020-05-14T04:00:56+00:00September 12, 2017|Categories: Patient, Policy|Tags: Albert Lea, Consolidation, Corporatization, Health Policy, Hospitals, Mayo Clinic, Rural Hospital|

A Two-Hospital Solution in the Event of a Mass Casualty Incident (MCI)

In June 2016, Kitsap County emergency personnel participated in Cascadia Rising, a large-scale earthquake drill. At the time, three local hospitals planned to coordinate management of injured casualties: Navy Hospital, which would treat the “walking wounded” (least injured), or Harrison Silverdale and Harrison Bremerton, which would clear their emergency departments to receive the flood of injured patients. While those plans have changed, the grave risk to our community in the event of an earthquake should not be ignored.

Niran Al-Agba2020-05-14T03:58:17+00:00September 5, 2017|Categories: Patient, Policy|Tags: ACA, Affordable Care, Cascade Rising, CHI, Consolidation, Dignity, Franciscan, Hospitals, Mass Casualty Incident, Patient Physician Relationship|

Washington State Regulators Gave CHI a Monopoly. It is Time to Take it Back.

How did we get here? America has struggled to balance access to hospital services with utilization, quality and price for the past 50 years. In the mid-1960’s, certificate of need laws were established to limit the supply of hospital beds and equipment, prevent overutilization of services, control costs and improve quality.

Niran Al-Agba2020-05-14T03:57:15+00:00August 22, 2017|Categories: Patient, Policy|Tags: Certificate of Need, CHI, CON laws, Consolidation, Corporatization, Franciscan, Hospitals, Rural Care, Washington State|

A Hospital With No Beds Cannot Stand

The evidence is now clear CON laws not only increase costs, but also restrict access for the underserved, especially in rural areas. Hospital bed access is expressed in the number of beds/1,000 population; on average, there are 3.62 beds/1,000 people in the United States. Recent studies by Strattman and Russ found states with CON laws have 1.31 fewer beds/1,000 overall. Kaiser Foundation found Washington and Oregon have the lowest bed ratios in the nation, at 1.7 beds/1,000, with Kitsap County having a woefully inadequate ration of 1.30 beds/1,000. In short, the evidence supports the fact that CON regulations worsen access for rural residents.

Niran Al-Agba2020-05-14T03:56:26+00:00August 15, 2017|Categories: Patient, Policy|Tags: Certificate of Need, CHI, CON laws, Corporatization, Franciscan, Health Policy, Hospitals, Rural Care, Washington State|

Phoebe-Putney Hospital vs. Lee County, Georgia: A Tale of Consolidation and a Little County That Could

Lee County is on their way to achieving something extraordinary; challenging the dominance of a hospital monopoly. On July 21, 2017, the CON application for Lee County was deemed complete by the Georgia Department of Community Health. A decision is anticipated by Nov. 15. If granted, the county plans to break ground on the new structure in early 2018. The CEO of Lee County Medical Center, Mr. G. Edward Alexander, stated “Our goal is to ensure that decisions for the hospital are made locally by people who live and work in Lee County.”

Niran Al-Agba2020-05-14T03:55:32+00:00August 8, 2017|Categories: Patient, Policy|Tags: ACA, Certificate of Need, CHI, CON laws, Consolidation, Corporatization, Franciscan, Health Policy, Phoebe Putney Hospital, Rural Care|

Healthcare Plan: Reboot and Rebuild

Success is never attained by taking shortcuts. We do not need reform of health care; we need to renovate the entire system. Special interests do not belong in the picture. They are superfluous to achieving innovative solutions that place profits on the back burner. Healthcare reform is like learning to discipline a tantrum-throwing 3-year-old; it will not conform to rhyme or reason. Congress is making this too difficult. They need to roll up their sleeves, go back to the drawing board, and start again.

Niran Al-Agba2020-05-26T01:30:54+00:00August 1, 2017|Categories: Patient, Policy|Tags: Affordable Care, Health Policy, Patient Physician Relationship|