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Kaiser Health News published two interesting articles this month that highlighted patients' struggles with medical bills: the earlier one reviewed some legislative proposals intended to limit patient liability in the case of surprise medical billing and emergency care, while the later one recounted some patient experiences with visiting the emergency room. The sustained interest and coverage regarding medical bills suggest that the nation will likely see some movement in this area, especially if the Democratic party gains control of both Congress and the presidency.

Kaiser Health News published two interesting articles this month that highlighted patients' struggles with medical bills: the earlier one reviewed some legislative proposals intended to limit patient liability in the case of surprise medical billing and emergency care, while the later one recounted some patient experiences with visiting the emergency room. The sustained interest and coverage regarding medical bills suggest that the nation will likely see some movement in this area, especially if the Democratic party gains control of both Congress and the presidency.

The second article highlights how visiting an out-of-network emergency room can be financially devastating. Normally, insurance will limit a person's annual expenses to a number known as the annual maximum out-of-pocket, which is $7,900 for individuals with ACA Marketplace plans in 2019. However, out-of-network medial care is not subject to that limit, even if that care might be emergency care. Hence, emergencies can be very expensive.

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Kaiser Health News published an article delving into why more approved generics are not making their way to the marketplace. In theory, streamlining FDA approval for generic drugs should mean more competition on the market, leading to reduced prices. However, the article points out that many approved generics are not even making it to the market, meaning that the emphasis on streamlining generics is not having the intended effect.

Kaiser Health News published an article delving into why more approved generics are not making their way to the marketplace. In theory, streamlining FDA approval for generic drugs should mean more competition on the market, leading to reduced prices. However, the article points out that many approved generics are not even making it to the market, meaning that the emphasis on streamlining generics is not having the intended effect.

The article lists several reasons that manufacturers might not sell the generics after they get approval. One seemingly mundane reason is that approval can take six to eight years, by which time the manufacturers may have turned their attention elsewhere or the market conditions might have changed. Streamlining the approval process should help in this regard. Other reasons seem less innocent: some generics manufacturers are approved, receive exclusivity for six months, and then accept money from the competing name-brand manufacturer to not sell. This practice seems anti-competitive, and the head of FDA has expressed hope that Congress can change the laws so that such companies forfeit their exclusivity if they do not actually sell the generics. It is apparent that there are other factors in play as well; approving generics is only one step.

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There is naturally some antagonism between providers (who understandably want to be paid more) and insurers (who understandably want to pay out less). Kaiser Health News highlighted some conflicts between large provider networks and large insurers.

There is naturally some antagonism between providers (who understandably want to be paid more) and insurers (who understandably want to pay out less). Kaiser Health News highlighted some conflicts between large provider networks and large insurers.

Payment schedule contracts can last a year or longer, and given the volume, a few percentage points can mean a lot for either side. Unfortunately, patients do not always know whether they will be able to keep their doctors until after the open enrollment period has passed, meaning that they have imperfect information. Regardless of which side might "win" a given negotiation, the consolidation of provider networks and insurers can result in deteriorating markets.

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The New York Times published an article underscoring how difficult it can be to use financial incentives to craft the right policies in light of inadequate or disputed measurements. Medicare had been seeing a number of its patients return to the hospital after a visit to the hospital. The readmissions were costly, and Medicare tried to reduce costs by imposing a financial penalty on those hospitals whose treatments resulted in above-average readmissions. The idea is that with a strong enough incentive, hospitals would find innovative ways of ensuring that patients would not unnecessarily require another hospitalization soon, whether through better discharge instructions or pro-actively communicating with primary care physicians or through other means. On paper, the readmissions rate did decrease; the article points out, however, that people dispute whether the readmissions rate decreased for the right reasons.

The New York Times published an article underscoring how difficult it can be to use financial incentives to craft the right policies in light of inadequate or disputed measurements. Medicare had been seeing a number of its patients return to the hospital after a visit to the hospital. The readmissions were costly, and Medicare tried to reduce costs by imposing a financial penalty on those hospitals whose treatments resulted in above-average readmissions. The idea is that with a strong enough incentive, hospitals would find innovative ways of ensuring that patients would not unnecessarily require another hospitalization soon, whether through better discharge instructions or pro-actively communicating with primary care physicians or through other means. On paper, the readmissions rate did decrease; the article points out, however, that people dispute whether the readmissions rate decreased for the right reasons.

Some studies suggest that the readmissions rate might have decreased simply because more patients have died while not being re-admitted to the hospital. Others point to a change in billing practices. For example, others have noted that hospitals will often place patients under observational status, rather than formally admitting them (which would count against the hospital). Patients might understand the difference, but the change in coding could affect the benefits that they are eligible for. Supporters of the program point to their own research suggesting that the program has so far been successful.

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Over the last two years, we have been doing a lot of behind-the-scenes work to upgrade our web framework (known as "changing out the tech stack" in some circles). We tried to avoid encumbering the process with new features while rewriting our software, and as a result, the external website largely looks the same as it did in 2017. With that process finally behind us, we have the opportunity to push forward with new features. This past week, we launched the first of those improvements: charting Medicare procedure volume by year.

Over the last two years, we have been doing a lot of behind-the-scenes work to upgrade our web framework (known as "changing out the tech stack" in some circles). We tried to avoid encumbering the process with new features while rewriting our software, and as a result, the external website largely looks the same as it did in 2017. With that process finally behind us, we have the opportunity to push forward with new features. This past week, we launched the first of those improvements: charting Medicare procedure volume by year.

Earlier, we had grouped Medicare procedure volume across years, but now, users can see how a doctor's procedure volume for Medicare patients may have varied over the years. The same goes for the pricing of the procedure. Hopefully, this is just the first of many improvements for the year.

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