Blog
At DocSpot, our mission is to connect people with the right health care by helping them navigate publicly available information. We believe the first step of that mission is to help connect people with an appropriate medical provider, and we look forward to helping people navigate other aspects of their care as the opportunities arise. We are just at the start of that mission, so we hope you will come back often to see how things are developing.
An underlying philosophy of our work is that right care means different things to different people. We also recognize that doctors are multidimensional people. So, instead of trying to determine which doctors are "better" than others, we offer a variety of filter options that individuals can apply to more quickly discover providers that fit their needs.
Got questions?Appellate court rules that federal government not liable for risk corridor program
A federal appellate court recently ruled that the federal government does not need to pay payments originally outlined as part of the Affordable Care Act's risk corridor program. The risk corridor program was to help mitigate the risk that an insurer would attract a disproportionate number of patients whose healthcare required higher medical costs. The original idea was that the federal government would contribute billions of dollars in the initial rollout of the Affordable Care Act. However, there were questions as to whether the funds were properly authorized and the current administration has declined to pay beyond what was collected from other insurers. Modern Healthcare published an informative background article in 2017.
Politico reported that a divided appellate ruled that insurers should not expect the federal government to pay what was originally planned in the Affordable Care Act, given that subsequent legislation required that the risk corridor payments not require any government funding. This seems like it would be a substantial disappointment for insurers that priced their premiums expecting that the government would subsidize some amount.
Department of Justice declines to defend key ACA provision
Attorneys general from twenty states filed a lawsuit in February of this year to nullify the Affordable Care Act (ACA). Typically, it falls on the executive branch to defend federal legislation, but the current administration filed a memorandum agreeing with the plaintiffs that key provisions of the ACA should be nullified: guaranteed-issue (that everyone can buy health insurance, regardless of pre-existing conditions and that insurers cannot raise prices for those who have pre-existing conditions) and community rating.
The arguments rely on previous Supreme Court commentary for two other cases in which plaintiffs argued that the ACA was unconstitutional. In the first case, NFIB v. Sebelius, the Supreme Court ruled that the federal government did indeed have constitutional authority to impose the individual mandate (a penalty for people who did not have health insurance) because it was a tax. In the second case, King v. Burwell, the Supreme Court ruled that the individual mandate is central to ACA. The plaintiffs in this case, Texas v. USA, argue that since the 2017 tax changes removed the individual mandate (a tax) and the individual mandate is central to ACA, the entire ACA must now be found unconstitutional. The Department of Justice in its memorandum did not go so far as the plaintiffs, but rather only agreed that guaranteed-issue and community rating should now be found unconstitutional.
The individual mandate and guaranteed-issue were the two most interesting features of the ACA. Interestingly, AHIP (which represents health insurers in the US) released a statement indicating that it was against the nullification of both guaranteed-issue and community rating.
"Right to try" law signed
As noted by many media outlets, the president signed legislation known as "right to try," where terminally ill patients will supposedly have better access to experimental medications. The move appears controversial, with various groups either diminishing the impact of the legislation or highlighting that it might make things worse for patients.
CBS News published a piece that gives an overview of the landscape before the legislation: although there was no federal legislation, 38 states already have similar laws. In addition, FDA already had a program in place where it approved of the vast majority of requests for experimental medication. Others have noted that easier access might mean that patients suffer more unsafe medications.
Incentives of insurance companies
Propublica published an interesting piece explaining why health insurers might actually not mind high prices from healthcare providers. In theory, the insurance company (the payer) wants to minimize its cost so that it can maximize its profits or at least offer more competitive offerings to its customers. The explanation for payers' acceptance of high prices is that while the profit in any given year is determined by the absolute difference between revenues and costs, the long-run profits of payers can essentially be modeled as a percentage of their total premiums collected. If true, the long-term incentive of insurance companies is not so much to minimize the absolute costs; rather, they benefit more as the costs rise from year to year.
Interestingly, the Affordable Care Act set a maximum percentage of premiums collected that insurance companies can use for non-medical purposes (including profits). In a non-competitive market with that regulation, insurance companies would indeed benefit from higher healthcare costs. Also interesting is the online resource that the article mentions in helping employees of certain companies shop for healthcare. Insurance companies could be rolling out their own versions of such tools, and one wonders why those tools are not more prevalent among insurance companies.
A review of quality metrics
The New England Journal of Medicine published a review of metrics used to assess the performance of healthcare providers. Some interesting statistics from the piece: "The National Quality Measures Clearinghouse now lists more than 2500 performance measures" and physician practices spend about $40,000 per physician annually to report on performance. This review was undertaken by the American College of Physicians (ACP). Of the 271 measures included in Medicare's Quality Payment Program, the ACP committee roughly roughly a third of them as valid, a third not valid, and a third of uncertain validity. The piece also talked about how different standards bodies come to adopt their measures.
A lot of money (and presumably attention) is supposedly being spent on collecting these performance metrics, and yet, patients lack visibility into physician performance. These standards bodies have been building consensus for years, perhaps even decades. One significant move to help drive adoption would be for industry groups (whether physician societies such as ACP or standards groups such as National Quality Forum or government agencies such as CMS) to genuinely push for metrics that are not disputed and push for the public disclosure of physician performance in those areas. While controversial, once a substantial number of physician groups start disclosing their performance, the public will come to expect these numbers and the debate around physician performance will beyond simply debating the validity of measures.