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.

Patients may start to pay more out-of-pocket for medications

by jerry on July 12, 2020

Kaiser Health News reported on a federal rule going into effect in 2021 that reduces the helpfulness of drug coupons from manufacturers. Even the background on this issue is complex: the pharmaceutical industry has evolved into a state where drug manufacturers charge high prices, but then offer large coupons to help individual patients offset the cost. The rationale for this arrangement is not entirely straightforward, but it is believed that it has a lot to do with the incentives of pharmacy benefit managers who act as purchasing intermediaries and some to do with helping the pharmaceutical industry be perceived more favorably by the public. The policy question that the federal rule addresses is: in terms of deductibles and copayments, which price of the drugs should be used: before the coupons are applied or the amount that patients actually paid?

Kaiser Health News reported on a federal rule going into effect in 2021 that reduces the helpfulness of drug coupons from manufacturers. Even the background on this issue is complex: the pharmaceutical industry has evolved into a state where drug manufacturers charge high prices, but then offer large coupons to help individual patients offset the cost. The rationale for this arrangement is not entirely straightforward, but it is believed that it has a lot to do with the incentives of pharmacy benefit managers who act as purchasing intermediaries and some to do with helping the pharmaceutical industry be perceived more favorably by the public. The policy question that the federal rule addresses is: in terms of deductibles and copayments, which price of the drugs should be used: before the coupons are applied or the amount that patients actually paid?

Counting the price of the drugs before the coupons helps the patients in that they very quickly meet their deductibles (and perhaps some out-of-pocket maximums), and insurance would more quickly start to pay. However, the idea behind insurance plan health design is that having patients shoulder more of their own healthcare costs will make them savvier consumers who will seek out better value (e.g. more earnestly explore alternatives), saving the overall system more money. To allow patients to skip the pain of deductibles and copayments would essentially short-circuit the principles behind many plan designs. Complicating this is that patients will be transitioning from the status quo, which allows them to apply the pre-coupon dollar figure (more favorable to them) to potentially a less favorable arrangement if their payers so choose. Also complicating this change is that drug prices have been rising very quickly in the past decade.

Read more

Oklahoma approves Medicaid expansion

by jerry on July 05, 2020

Associated Press reports that Oklahoma approved Medicaid expansion, which means that the state government will subsidize health insurance so that more people will be able to afford it. This decision by voters contrasts with the state's earlier persistent refusal. Interestingly, the article notes that this decision was done through a constitutional amendment, meaning that the state legislature by itself would not able to overturn the decision in the future.

Associated Press reports that Oklahoma approved Medicaid expansion, which means that the state government will subsidize health insurance so that more people will be able to afford it. This decision by voters contrasts with the state's earlier persistent refusal. Interestingly, the article notes that this decision was done through a constitutional amendment, meaning that the state legislature by itself would not able to overturn the decision in the future.

The passage of the Affordable Care Act (ACA) was controversial, and opponents have challenged various parts of it. One controversial aspect of the bill was whether or not to expand Medicaid coverage so that more people who could not afford health insurance would be able to get it through Medicaid (known as Medicaid expansion). The Affordable Care Act had the federal government initially pay for much or all of the additional cost, but then after a period of several years, states would be liable. Several states balked at the prospect of having to pay more to subsidize health coverage. Over time, the opposition to the Affordable Care Act has eroded some, although there is still an ongoing court case to overturn it completely. It could be that as more people have experienced having health insurance, more people have been feeling that everyone should be able to have it.

Read more

Tentative victory for procedure pricing transparency

by jerry on June 27, 2020

In a tentative victory for healthcare pricing transparency, Reuters reported that a federal judge dismissed a challenge filed by American Hospital Association (AHA) against the current administration's requirement that hospitals publicly disclose procedure pricing. The requirements came out as a proposal last year, and industry expected the requirements to be challenged. AHA plans on appealing the decision, so the ruling might not be final.

In a tentative victory for healthcare pricing transparency, Reuters reported that a federal judge dismissed a challenge filed by American Hospital Association (AHA) against the current administration's requirement that hospitals publicly disclose procedure pricing. The requirements came out as a proposal last year, and industry expected the requirements to be challenged. AHA plans on appealing the decision, so the ruling might not be final.

Reuters reported that AHA claimed that the disclosure requirements would undermine competition. It is difficult to understand that claim. The AHA made other claims (such as hospitals "resources are stretched thin and need to be devoted to patient care," similar to what the cell phone service providers claimed when forced to support phone number portability), but this particular claim of undermining competition seems far-fetched. Reuters also notes that hospital groups claimed that requiring disclosure of negotiated charges "would create confusion about patients' out-of-pocket costs, not prevent it" -- a claim that appears rather condescending. While disclosure of the prices may indeed be confusing, it at least provides a starting point with actual data. The status quo generally involves phone calls to confused hospital phone operators who might or might not be able to answer the question of pricing.

Read more

Sutter tries to renegotiate settlement

by jerry on June 20, 2020

Following up on news that they reported late last year, Kaiser Health News recently reported on Sutter Health, a large medical system in Northern California, which now seeks to reduce the terms of its settlement. Sutter was accused of anticompetitive behavior and of being responsible for higher prices in their area.

Following up on news that they reported late last year, Kaiser Health News recently reported on Sutter Health, a large medical system in Northern California, which now seeks to reduce the terms of its settlement. Sutter was accused of anticompetitive behavior and of being responsible for higher prices in their area.

This article relayed that Sutter is asking for the terms of the settlement to be reduced given the financial hardships imposed by the pandemic. The argument that Sutter seems to be making is that they are operating at such a loss that the terms of the settlement (agreed upon before the pandemic), would force them to compromise the quality and/or extent of care they can provide. Apparently, Sutter not only objects to the size of the financial settlement, but also wants to roll back some of the other parts of the agreement, including forcing payers to accept their entire network (or none at all) and limiting rate increases. Clearly, there is a lot at stake financially for Sutter, but the attempt to renegotiate the non-financial terms raises questions around the extent to which Sutter is trying to capitalize on the current circumstances.

Read more

Some practices dropping Medicare

by jerry on June 14, 2020

In economics, there is supply and there is demand. When growth in demand outstrips growth in supply, prices increase. When a price ceiling is put in place to restrain prices, the market usually encounters a situation where not everyone who can afford to buy can actually do so. Kaiser Health News reported on the general shortage of primary care doctors in the US, with an emphasis on Medicare patients' inability to find doctors. Medicare, while heralded as a success for elderly patients, typically pays less than commercial payers. Up until somewhat recently, many practices had to accept Medicare simply because of the number of Medicare patients. With supply not being able to keep up with demand, some practices have made business decisions to not accept Medicare patients.

In economics, there is supply and there is demand. When growth in demand outstrips growth in supply, prices increase. When a price ceiling is put in place to restrain prices, the market usually encounters a situation where not everyone who can afford to buy can actually do so. Kaiser Health News reported on the general shortage of primary care doctors in the US, with an emphasis on Medicare patients' inability to find doctors. Medicare, while heralded as a success for elderly patients, typically pays less than commercial payers. Up until somewhat recently, many practices had to accept Medicare simply because of the number of Medicare patients. With supply not being able to keep up with demand, some practices have made business decisions to not accept Medicare patients.

Some people have tried to portray greedy doctors as being the reason for the difficultly that Medicare patients have when searching for a new doctor. In reality, if commercial insurers pay significantly more than Medicare does, it can often be a very difficult business decision to continue to accept Medicare, especially when the average salary of primary care doctors is only about 80% of the average salary across all specialties (per the article). A more systematic fix would be to allow prices to adjust annually, allowing the under-compensated specialties to be paid more and hopefully drawing more doctors into the field (thus increasing supply).

Read more