Jared Rhoads

Do Cash-Only Ambulatory Surgical Centers Really Threaten Critical Access Hospitals? An initial and potentially sufficient look at the question.

"Cash-only ASCs can be thought of as positive contributors to healthcare service abundance, providing care to a particular segment of the market, and helping to control costs by practicing radical price transparency." centerformodernhealth.org/publications...

Can anyone cite an example in the U.S. of a Critical Access Hospital shutting down due to a cash-only, direct-pay surgery center opening up nearby?

New Englander here filling out a survey for the Arbor Day Foundation. Yep, I like trees. Couldn't live in the southwest (at least not permanently).

Should I start selling conch shells to fund my health policy work? I'd have a stronger evidence base than most supplement-hawking influencers. publications.ersnet.org/content/erjo...

Schools Should Set Their Own Smartphone Policies Phone-free school is a sensible goal, but policy should be set by schools and school districts, not state legislatures.

A year ago I was worried that the school smartphone issue, if taken up by state legislators, would become politicized (see below). Things haven't really played out that way, but it's still possible. centerformodernhealth.org/publications...

Targeted Regulations Of Abortion Providers Associated With Significant Decreases In OB-GYN Density, 1993–2021 | Health Affairs Journal Obstetricians and gynecologists (OB-GYNs) provide essential health care to women across their lifespan. Yet nearly half of US counties have no OB-GYNs, with nonmetropolitan communities disproportionately affected. Targeted Regulation of Abortion Providers (TRAP) laws, spurred by the 1992 US Supreme Court decision in Planned Parenthood v. Casey, impose regulatory burdens on abortion providers and may have influenced whether and where OB-GYNs choose to practice, which has not yet been comprehensively studied. Using a staggered difference-in-differences design and county-level data, we found that TRAP laws were associated with an average reduction of 4.67 percent in the density of OB-GYNs per 100,000 women ages 15–44 during the period 1993–2021, between Casey and the Dobbs v. Jackson Women’s Health Organization decision in 2022. TRAP laws affected both general and fellowship-trained OB-GYNs, as well as counties without abortion facilities. Concerningly, TRAP laws led to lower physician density in nonmetropolitan counties—a difference that persisted for a decade. As OB-GYN shortages are projected to worsen and TRAP laws are still in effect in twenty-four states, policy makers should consider the long-run effects of TRAP laws on women’s access to health care and their potential to exacerbate geographic disparities in access to care.

Nearly half of US counties have zero OB-GYNs. And where there are OB-GYNs, the existence of TRAP laws (Targeted Regulation of Abortion Providers) appear to be associated with about a 5 percent reduction in OB-GYN physician density. www.healthaffairs.org/doi/full/10....

When an Insurance Rep Calls Mid-Surgery: What's the Real Breakdown? Why are insurers even in this position to begin with?

I recall a 2016 survey that showed that something like 5% of employers (ERISA plans) used reference-based pricing, but 60% planned to adopt it within 5 years. Did that ever happen? Has anyone seen newer data? My recent article mentioning RBP: centerformodernhealth.org/publications...

We need more freedom for adults, coupled with more serious enforcement with regard to selling and supplying to kids. There's an opportunity for an education and awareness role for nonprofits, and believe it or not, probably online influencers too.

Minor hospital weirdness: why do Emergency Departments ask *patients* to sign a non-discrimination form at intake? The patient isn't really agreeing to do or not do anything; it's a commitment the hospital makes to treat people a certain way. Could be a poster on a wall.

Question for policy wonks on all sides: what's causing ambulance deserts? I can name several possible factors, but I don't have data. Do we know?

There is no supernatural mechanism by which we can transfer the cost of medical care from individuals to "someone else." If it's to employers, we pay via lower wages. If it's to insurance companies, we pay via higher premiums. If it's to the government, we pay via higher taxes.

There are many examples of NIMBYism in healthcare, but opposition to overdose prevention centers (OPCs) might be the plainest. It would be understandable if OPCs were associated with increased crime, but they generally aren't. centerformodernhealth.org/publications...

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Heard this weekend that some states have come out with "product directories" listing which flavored tobacco and e-cigs stores *can* sell, instead of listing what they *can't* sell. Though I bet the clarity helps stores ensure compliance, it seems like a loss in terms of freedom.

A scholarly paper presented this morning at APSA found that, counter-intuitively, Red states have much more generous Medicaid policies for immigrant populations. The thinking is that it is a side effect of the way different states do unborn child credits.

You know how people talk about trying to quit smoking, and failing? I just saw a post by the VA that put things differently. It talked about "practicing going tobacco-free." As in, hey, it's probably going to take some practice before you're able to do it. Way better framing.

Here's an argument for Right to Try that perhaps my Democrat friends will like. Maybe you're happy with FDA's Expanded Access program when your party is in power. But given the past five months, are you sure you wouldn't like RTT as a backup, just in case? centerformodernhealth.org/publications...

The arguments against Right to Try are not very strong. Consider the objection that the FDA's Expanded Access already works fine. Even assuming the application process is quick and the approval rate is high, at most that makes RTT duplicative, not something that must be rejected.

Right to Try lets patients bypass the FDA and deal with pharma companies directly. ("One less entity that might turn them away.") Expanded Right to Try makes sure there are adequate protections in place with regard to liability and informed consent. centerformodernhealth.org/publications...

The Expanded Right to Try movement seeks to fix two things about Right to Try: lingering civil liability and ambiguity around informed consent. New Hampshire HB 701 is a bill I support. It has already passed in the House; now on to the Senate. centerformodernhealth.org/publications...

My latest on efforts to pass state-based Expanded Right to Try laws. In short, I'm for them. centerformodernhealth.org/publications...

Private Equity Among US Psychiatric Hospitals This study describes trends in private equity ownership of psychiatric hospitals from 2013 through 2021 and the cross-sectional association between private equity ownership and hospital staffing and q...

The evidence against private equity in healthcare is more mixed than PE critics would have you believe. Case in point: here's a new study finding PE ownership is associated with lower RN staffing but higher quality measures in psychiatric hospitals. jamanetwork.com/journals/jam...

Bookman: Sponsor of Georgia abortion ban spared trauma of watching brain dead loved one carry fetus • Georgia Recorder By most common measures, the life of Adriana Smith ended three months ago, when a tragic series of undiagnosed blood clots left her brain dead, with no hope of recovery. Yet today, in a hospital room ...

I'd be interested to know how many supporters of Georgia's LIFE Act consider the case of Emory Hospital keeping Adriana Smith on life support as an example of unintended consequences, and how many consider it working exactly as intended. georgiarecorder.com/2025/05/21/b...

Reminder! For the month of May, we're doing a special fundraiser. To anyone who donates $25 or more to our @gofundme.com, we'll mail you a DVD of Leonard Peikoff's superb 1985 Ford Hall Forum talk on government influence in modern medicine. centerformodernhealth.org/support.php

Extending SBHC access to homeschoolers could be brought about legislatively, though, if there was enough desire. (Which there probably isn't.) Nevertheless, it's interesting to contemplate.

Courts would likely view access to SBHCs as similar to access to school meals, afterschool tutoring, or building amenities. And I bet a court would find that there's a rational basis for limiting such services to enrolled public school students.

I'm a policy person, not a legal expert--two different things--but I'm thinking probably not. Equal Protection prohibits states from denying any person equal protection of the laws, but that likely does not include a right to equal access to school-administered services.

School-Based Health Centers and School Attendance in Rural Areas This cross-sectional study assesses whether student absenteeism is less frequent in rural school districts with vs without school-based health centers.

With rising interest in school-based health centers (SBHCs), I've been wondering whether it would violate the Equal Protection Clause for a state to operate SBHCs exclusively for public school students and to deny access to homeschooled children. jamanetwork.com/journals/jam...

Is it too early to call the Bootlegger-and-Baptist coalition that is going to emerge as a predictable consequence of smartphones and excessive ed tech? (Pharma putting out a dopamine regulator for kids, and "child health advocates" demanding it be covered by insurance.)

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