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Kaiser Health News reports on an interesting shift in attitude towards single-payer healthcare among doctors. It appears that many of the younger physicians are "accepting" of more government involvement to help ensure that more people can have healthcare. The article notes that opposition to single-payer healthcare remains steadfast among older doctors.
The attitudes among the general population also seem to be shifting. There's an interesting quote in the article:
"'Few really understand what you mean when you say single-payer,' said Dr. Frank Opelka, the medical director of quality and health policy for the American College of Surgeons, which opposes such a policy. 'What they mean is, "I don't think the current system is working."'"
There can be many different variations on exactly how healthcare access can be expanded (and even what single-payer healthcare might mean), but it seems that more people are coming to the conclusion that our current system is not the best for people in general.
Along with the changes noted in last week's blog post, CMS proposed some changes to how physicians will be compensated. Kaiser Health News offered some analysis regarding the effects of the proposed changes.
CMS touted the changes as a way that providers can save time, since there should be less complexity and less paperwork. Interestingly, CMS is proposing to pay primary care providers and specialists the same amount for a typical office visit. People in the industry have been concerned about the increasing disparity between the compensation for primary care doctors as compared to that of specialists (causing more and more providers to specialize, leading to a shortage of primary care doctors). This change might slow that trend.
Regardless, the article canvases a number of physicians and demonstrates that it can be difficult to fully appreciate the impact of policy changes like these, in part, because it is difficult to predict how providers might change their practice in response. A number of providers appear to be asking for a pilot to better understand the effects.
The Centers for Medicare & Medicaid Services (CMS) filed a lengthy document outlining a number of changes to its payment policies.
Of note, on page 19 of the document, CMS proposes to pay the same amount for the same procedure, regardless of whether the procedure was done in a hospital or in an outpatient setting (the new policy is known as "site neutrality"). Earlier, hospitals had made the case that they should be compensated more because they maintained equipment and access to more intensive care facilities if the need ever arose. Because of this differential, some had accused hospitals of buying up physician practices with the express intention of being able to collect more revenue for the same procedures by labeling the venues as hospitals.
On page 638, the document outlines the continued interest in transparency of pricing information, requiring, for example, hospitals to post their prices online in a machine-readable format (starting at the beginning of 2019).
The comment period goes through September of this year.
The New York Times published a piece about how high administrative costs are in U.S. healthcare. Some interesting statistics include: a 1999 study estimating that about 30 percent of U.S. healthcare expenditures were because of administration and an estimate that seven additional people are needed for billing-related activities for every ten physicians providing care. The piece cited a study that estimated that about 80% of the nearly half-trillion dollars spent on U.S. healthcare administration in 2012 was due to the complexity of a multi-payer system.
Administrative costs can be from the provider's office (which hire medical coders to submit claims) and from insurance companies (which use software and humans to review the submitted claims). In some sense, the administrative costs related to billing on both sides represent the prisoners' dilemma. Initially, insurance companies might have simply just paid submitted claims. Over time, as costs grew and grew, insurance companies instituted policies to help reduce costs (part of which was fraud). As insurance companies introduced these policies, providers' offices likely quickly realized that they needed to devote more time to claim submissions, including some providers that might submit claims with higher severity than warranted (upcoding). That, in turn, likely prompted insurance companies to institute still more complex procedures and so on. In theory, if both sides went back to original arrangement and importantly, if no one ever cheated, both sides could save a lot on administrative costs. The lure, however, of easy short-term profits will be difficult for some on both sides to turn down.
Health Affairs published a piece that promotes transparency in healthcare pricing, describes efforts to increase it, and offers ideas on how to further the cause. Some previous state-level efforts include requiring hospitals to publish prices and collecting claims data in what are known as all-payer claims databases.
The piece notes that an increasing number of states appear to be moving towards the creation of all-payer claims databases and suggests that the federal government could reduce the overall friction in data collection by creating a common standard. The piece ends by noting that while investments in all-payer claims databases might yield substantial benefits, it might take a while before states begin to see those benefits.