Operational impact of telehealth pay parity

In the fee-for-service environment that is common in the US for acute care, duplicate visits resulting from telehealth lead to an incentive alignment problem because they generate excess demand and provider revenue, without any corresponding increase in patient access.

Read the paper published at M&SOM

Telehealth pay-parity laws and regulations require payers to cover and reimburse certain healthcare services provided remotely to the same extent as if those services were delivered in a traditional office setting. COVID-19 has spurred additional proposed and enacted legislation aimed at ensuring telehealth pay parity. The primary argument for telehealth pay parity is that it promotes access to care and also provides better health outcomes for certain illnesses; but research shows that patients seeking acute care via telehealth may be more likely to require a duplicate visit. Several open questions remain regarding the business impact of telehealth pay-parity policies and the future of telemedicine in healthcare practices.

Read the article at Health Management, Policy, and Innovation

Research highlight: operational impact of hospitalist workload

We show that hospitalists are effective at reducing LOS for patients with complex conditions, corroborating intuitive reasoning. However, the optimal hospitalist case-mix also includes “simple” patients with few interventions and short LOS, as they can effectively reduce discharge delays. This actionable insight is particularly salient for small community hospitals with simple, short-stay patients, where hospitalists may be undervalued due to the prevailing belief that they are primarily effective for complex patients.

Read the article, which was published in Management Science.

COVID-19

• Test allocation and pool composition in heterogenous populations under strict capacity constraints (with Serhan Ziya). Motivated by the persistent lack of testing capacity in the COVID-19 pandemic, we study the question “who should be tested?” when capacity is limited, tests have errors, and patients differ in their prior probability of being infected. Working paper available: Optimal Testing under Limited Capacity .

Epidemics pose challenges to the healthcare system that are primarily operational rather than clinical. Healthcare providers usually know what kind of care the patients need, but lack the resources to provide it. Many of the lessons from mass-casualty management can also improve the management of an epidemic.

Read the article in Health Management, Policy, and Innovation special issue on COVID-19 (March 16, 2020).

Selected research awards

• POMS College of Healthcare Operations Management best paper, 2018. For “Mixing it up: Operational impact of hospitalist workload”.
• Operations and Decision Technologies Faculty Scholar Award, 2018.
• INFORMS Public Sector Operations Research paper competition, second prize 2014. For an earlier version of “surge capacity” research.
• INFORMS Doing Good with Good OR paper competition, finalist 2012. For my research on patient prioritization in a mass-casualty incident.

Selected Papers

Alex F. Mills CV

Alex F. Mills SSRN author page

Recently Published

• Telehealth in Acute Care: Pay Parity and Patient Access. With O. E. Cakici in Manufacturing & Service Operations Management.
• Mixing it up: Operational impact of hospitalist workload. With M. Kamalahmadi, K. Bretthauer, J. Helm, and healthcare industry collaborators in Management Science.
• Medical Surge: Lessons for a Pandemic from Mass-Casualty Management. With J. Helm in Health Management, Policy, and Innovation special issue on COVID-19, March 2020. We outline lessons hospitals can learn from the mass-casualty management literature and apply to a pandemic like COVID-19.
• Surge capacity deployment in hospitals: effectiveness of response and mitigation strategies. With J. Helm and Y. Wang. We study responsive and mitigative actions that hospitals can take to improve surge capacity when demand from high-acuity patients exceeds the capacity to care for them. We show how hospital and demand characteristics affect the optimal strategy. Manufacturing & Service Operations Management
• On the role of teletriage in healthcare demand management. With O. E. Cakici.
  Despite a growing push for telemedicine, we find that teletriage (a service that provides information about a patient’s medical condition) can make the patient’s healthcare access decision worse if patients overweight low-probability events when making decisions. Manufacturing & Service Operations Management.
• Incentive-compatible prehospital triage. With E. Webb. We investigate whether and to what extent prehospital triage (i.e., by the EMS service) is compatible with common healthcare reimbursement structures. We find that reimbursement incentives may have a larger impact than triage effectiveness on the adoption of prehospital triage. Production and Operations Management September 2019.
• Behavior aware service staffing. With D. Cho, K. Cattani, and K. Bretthauer. We study speedup and slowdown in a service environment and its impact on staffing decisions. Production and Operations Management May 2019.