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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.

Criticisms of Medicare Advantage plans

by jerry on July 03, 2022

Kaiser Health News reported on some lingering problems with Medicare Advantage plans, which are plans that are administered by private companies and paid a set amount per patient. The idea was to give private industry a profit incentive to operate more efficiently than Medicare, allowing companies to keep savings. One problem is that the quality of health coverage provided by these plans is difficult to assess, and it is easier for to companies to cut corners to save money than it is for them to implement innovative techniques that both save money while maintaining or improving quality. This lack of transparency with quality can be particularly problematic since patients might make different decisions if they knew certain implications.

Kaiser Health News reported on some lingering problems with Medicare Advantage plans, which are plans that are administered by private companies and paid a set amount per patient. The idea was to give private industry a profit incentive to operate more efficiently than Medicare, allowing companies to keep savings. One problem is that the quality of health coverage provided by these plans is difficult to assess, and it is easier for to companies to cut corners to save money than it is for them to implement innovative techniques that both save money while maintaining or improving quality. This lack of transparency with quality can be particularly problematic since patients might make different decisions if they knew certain implications.

Complaints with Medicare Advantage plans including patients "facing 'unwarranted barriers' to getting care," perhaps at least in part explaining why "seniors in their last year of life had dropped out of Medicare Advantage plans at twice the rate of other patients leaving the plans."

On the financial side of the program, Medicare Advantage plans have an incentive to rate their patients as sicker than they actually are (to receive greater compensation), and an audit showed that "35 of 37 plans picked for audit had been overpaid, sometimes by thousands of dollars per patient."

It seems that the federal government is not receiving the intended value of Medicare Advantage plans. Even beyond that, the article reports that the Centers for Medicare and Medicaid (CMS) is over a decade behind completing audits, which can be a step towards rectifying some of the problem.

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Mounting frustration with medical billing prompts legislative proposals

by jerry on June 26, 2022

Kaiser Health News published an article covering some legislative proposals in North Carolina regarding medical debt. Predictably, the article starts with a personal anecdote about how medical debt distressed an individual. After listing two more personal anecdotes, the article goes on to describe two legislative initiatives meant to curtail the burden of medical debt among the low-income residents of North Carolina: one being the adoption of Medicaid expansion (previously opposed by Republicans) and one to grant additional protections to low-income individuals.

Kaiser Health News published an article covering some legislative proposals in North Carolina regarding medical debt. Predictably, the article starts with a personal anecdote about how medical debt distressed an individual. After listing two more personal anecdotes, the article goes on to describe two legislative initiatives meant to curtail the burden of medical debt among the low-income residents of North Carolina: one being the adoption of Medicaid expansion (previously opposed by Republicans) and one to grant additional protections to low-income individuals.

While it may be unclear whether these particular proposals become law, it does seem that mounting grievances towards medical billing will likely end up triggering more government involvement of some sort. A $30,000 medical bill for a visit to the emergency room (the second personal anecdote) seems extraordinarily high, even by US healthcare standards; the distress was compounded by the hospital suing the couple, who feared loss of their home. Not specific to the healthcare industry, it also seems that when an institution makes a mistake and requires several hours of a customer's time to remedy the issue (the third anecdote), that institution should bear some financial responsibility for causing the loss of the customer's time. While individual institutions might be optimizing for their short-term bottom line, continuing to do so in this political climate could lead to heavier regulation or other government involvement.

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Medical debt across America

by jerry on June 20, 2022

Kaiser Health News published an extended piece about medical debt among Americans. The investigation drew upon the results of a survey, and the findings presented in the article seem bleak. The survey of almost 2,400 adults found, for example, that over 40% of U.S. adults "currently have some debt caused by medical or dental bills" and that half U.S. adults "don't have the cash to cover an unexpected $500 health care bill." Beyond that, the survey asked questions that might not normally be covered when researchers analyze medical debt. For example, the poll found that 10% of survey respondents "owe money to a friend or family member who covered their medical or dental bills" and over 15% of survey respondents "are paying off a medical or dental bill they put on a card" -- both forms of medical debt that might not show up in traditional analysis.

Kaiser Health News published an extended piece about medical debt among Americans. The investigation drew upon the results of a survey, and the findings presented in the article seem bleak. The survey of almost 2,400 adults found, for example, that over 40% of U.S. adults "currently have some debt caused by medical or dental bills" and that half U.S. adults "don't have the cash to cover an unexpected $500 health care bill." Beyond that, the survey asked questions that might not normally be covered when researchers analyze medical debt. For example, the poll found that 10% of survey respondents "owe money to a friend or family member who covered their medical or dental bills" and over 15% of survey respondents "are paying off a medical or dental bill they put on a card" -- both forms of medical debt that might not show up in traditional analysis.

The article also discussed some consequences of the debt, starting with the patients' inability to pay and their subsequent harassment by debt collectors. About two-thirds of respondents apparently have delayed care that either they or a family member has needed, and about "1 in 7 people with debt said they've been denied access to a hospital, doctor, or other provider because of unpaid bills." These statistics seem grim, and perhaps suggest that there might be widespread support for something in the industry to change substantially.

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Old policies hamper treatment

by jerry on June 12, 2022

Kaiser Health News reported on some challenges that primary care providers are facing when they treat mental health issues. Apparently, in the 1980s, many insurers issued policies to separate mental health treatment from treatment of more traditional medical concerns by separating out the network of providers who could be reimbursed for mental health treatment. Since then, it appears the separation has grown. The original reasoning might have made sense: steering patients towards specialists, who might have been able to offer higher quality at lower costs. However, the insurers' rationale might have ignored patients' preferences. Apparently, "primary care physicians handled nearly 40% of all visits for depression or anxiety and prescribed half of all antidepressants and anti-anxiety medications." Given how frequently primary care physicians treat mental health issues, it seems that separating the provider networks would pose significant burdens on patients.

Kaiser Health News reported on some challenges that primary care providers are facing when they treat mental health issues. Apparently, in the 1980s, many insurers issued policies to separate mental health treatment from treatment of more traditional medical concerns by separating out the network of providers who could be reimbursed for mental health treatment. Since then, it appears the separation has grown. The original reasoning might have made sense: steering patients towards specialists, who might have been able to offer higher quality at lower costs. However, the insurers' rationale might have ignored patients' preferences. Apparently, "primary care physicians handled nearly 40% of all visits for depression or anxiety and prescribed half of all antidepressants and anti-anxiety medications." Given how frequently primary care physicians treat mental health issues, it seems that separating the provider networks would pose significant burdens on patients.

The article discusses how insurers will deny mental health claims from primary care physicians, which resulted in some billing their treatment under different procedure codes. Overall, the current policy of separating provider networks (even though many patients consult primary care physicians about mental health issues) seems short-sighted: insurers might be able to save on some claims in the short-run, but the policy likely drives up costs for providers who must then track more administrative rules or drives up costs in general as patients need to see more providers resulting in more visits.

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Billing nuances

by jerry on June 05, 2022

Kaiser Health News published a piece on how a slight difference in how a procedure was billed made a significant financial difference for the patient. As background, the Affordable Care Act mandated that certain preventative care procedures (e.g. routine check-ups) would not cost insured patients anything out-of-pocket with the hope that more people would undergo preventative care and avoid more costly care. A screening colonoscopy is an example of such preventative care procedures. However, diagnostic colonoscopies -- which might be prescribed to determine if a patient has colon cancer -- can still be billed as non-preventative care, thereby costing some patients. Presumably, healthcare providers get paid much more for diagnostic colonoscopies than they do for screening colonoscopies, tempting many to bill for the more profitable procedure. In turn, Medicare has clarified that the removal of a polyp (relevant to the patient's colonoscopy described in the article) does not warrant changing a screening colonoscopy to a diagnostic one. However, it seems like some providers persist in the more lucrative billing. In this particular piece, the patient expected her colonoscopy to be a screening procedure and therefore not to cost her anything. She was billed over $2,000, and the provider persisted in billing her procedure as diagnostic rather than as screening (even when a representative from the insurance company was present). After being contacted by Kaiser Health News, the provider admitted making a mistake and re-submitted the procedure as a screening colonoscopy.

Kaiser Health News published a piece on how a slight difference in how a procedure was billed made a significant financial difference for the patient. As background, the Affordable Care Act mandated that certain preventative care procedures (e.g. routine check-ups) would not cost insured patients anything out-of-pocket with the hope that more people would undergo preventative care and avoid more costly care. A screening colonoscopy is an example of such preventative care procedures. However, diagnostic colonoscopies -- which might be prescribed to determine if a patient has colon cancer -- can still be billed as non-preventative care, thereby costing some patients. Presumably, healthcare providers get paid much more for diagnostic colonoscopies than they do for screening colonoscopies, tempting many to bill for the more profitable procedure. In turn, Medicare has clarified that the removal of a polyp (relevant to the patient's colonoscopy described in the article) does not warrant changing a screening colonoscopy to a diagnostic one. However, it seems like some providers persist in the more lucrative billing. In this particular piece, the patient expected her colonoscopy to be a screening procedure and therefore not to cost her anything. She was billed over $2,000, and the provider persisted in billing her procedure as diagnostic rather than as screening (even when a representative from the insurance company was present). After being contacted by Kaiser Health News, the provider admitted making a mistake and re-submitted the procedure as a screening colonoscopy.

While this case was resolved in favor of the patient, it is unfortunate that the provider admitted to making a mistake only after media's involvement. There must be many, many other cases in which media does not get involved, and patients might have little practical recourse when providers insist they are correct.

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