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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.

Hospital accused of altering health records to avoid culpability

by jerry on March 07, 2021

NBC News published an alarming article detailing patient accusations of a hospital misdiagnosing and then altering the patient's medical record to avoid guilt. If true, the allegations are quite concerning. From what has been pieced together, the hospital originally declared the patient to be free of cancer, but that diagnosis was apparently the result of a technician accidentally selecting the wrong value from a dropdown menu despite leaving a contradictory textual comment. When the patient eventually learned from a second opinion that she had cancer, she was diagnosed with stage 4 and advised that she might have less than a year to live. One might be skeptical of a single patient's accusations, and I was surprised to learn that a forensics firm worked on about 500 medical malpractice cases and found "significant alterations to the patient's record that favored the hospital in 85 percent of them."

NBC News published an alarming article detailing patient accusations of a hospital misdiagnosing and then altering the patient's medical record to avoid guilt. If true, the allegations are quite concerning. From what has been pieced together, the hospital originally declared the patient to be free of cancer, but that diagnosis was apparently the result of a technician accidentally selecting the wrong value from a dropdown menu despite leaving a contradictory textual comment. When the patient eventually learned from a second opinion that she had cancer, she was diagnosed with stage 4 and advised that she might have less than a year to live. One might be skeptical of a single patient's accusations, and I was surprised to learn that a forensics firm worked on about 500 medical malpractice cases and found "significant alterations to the patient's record that favored the hospital in 85 percent of them."

Putting aside the shocking cover-up (if true), this case highlights that both the patient and the hospital might have been better off if the patient had full access to her medical records in this case. Many medical providers have been reluctant to fully share patient medical records, for fear of misinterpretation, additional questions, or perhaps mistakes that might be uncovered by patients. However, increasing reliance on software might make it easier for mistakes to slip by (whereas in older times, perhaps the referring doctor would have seen the textual comment). Electronic health records bring many benefits over paper records, but they are still vulnerable -- and perhaps especially so -- to bad input. Allowing patients to have full and easy access to their own medical records could be an important tool in catching mistakes early.

Additionally, watching hospitals complain about the cost and complexity of accessing the audit log is concerning. If the number of accusations of cover-ups rises significantly, the medical industry would ideally have an incentive to have an easier time to access and interpret the audit log rather than use it as a smokescreen to deny wrongdoing.

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Hospitals push back on Medicare measures

by jerry on February 28, 2021

Kaiser Health News published an article about 774 hospitals penalized because of patient complications. Medicare has adopted a carrot-and-stick approach to get hospitals to perform better (e.g. fewer complications and re-admissions). Naturally, hospitals criticize Medicare's program.

Kaiser Health News published an article about 774 hospitals penalized because of patient complications. Medicare has adopted a carrot-and-stick approach to get hospitals to perform better (e.g. fewer complications and re-admissions). Naturally, hospitals criticize Medicare's program.

In particular, some hospitals suggest that they have been penalized simply because they are more thorough in reporting infections and other complications to Medicare. If true, this means that evaluation of the hospitals relies in part on self-assessment and is vulnerable to abuse. While most hospitals may be honest, it seems likely that some will overlook what they consider minor issues. Even putting aside fraud, there is the very real possibility that different hospitals simply have different standards for what is considered a complication.

Some hospitals also complain that they have sicker patients who are more likely to be re-admitted. Assuming that Medicare already risk-adjusts for patient population, hospitals appear to be taking issue with Medicare's risk-adjustment model. It seems unlikely, however, that the entire medical industry would be satisfied with any one risk-adjustment model at this point.

Some other hospitals appear to complain about being pitted against one another ("tournament" model), where being "good" is not enough... hospitals need to be in a certain tier relative to other hospitals. Understandably, Medicare does not want hospitals to stop improving, but some hospitals seem to think that the improvements are so small now that differences in ranking are essentially meaningless and they would rather Medicare adopt fixed thresholds. Needless to say, if Medicare proposed fixed thresholds that were too stringent, hospitals would also complain.

Overall, it seems clear that there may be a variety of issues with the way that Medicare encourages hospitals to perform better. Nevertheless, Medicare does seem to be pushing the industry forward, not letting perfection be the enemy of progress.

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California assembly member introduces single-payer proposal

by jerry on February 21, 2021

Kaiser Health News reported on a legislative initiative to move California to a single-payer healthcare system. About 20 state assembly members have indicated support for the legislation. Of note, analysis of a prior single-payer proposal projected the cost at $400 billion, which is approximately twice the governor's proposed state budget of $227 billion. The assembly member who introduced the bill seems to think current funding for health care (probably including privately paid premiums) might be re-routed to pay for the proposal.

Kaiser Health News reported on a legislative initiative to move California to a single-payer healthcare system. About 20 state assembly members have indicated support for the legislation. Of note, analysis of a prior single-payer proposal projected the cost at $400 billion, which is approximately twice the governor's proposed state budget of $227 billion. The assembly member who introduced the bill seems to think current funding for health care (probably including privately paid premiums) might be re-routed to pay for the proposal.

The proposal appears generous, ending all out-of-pocket costs (even copays and deductibles). However, requiring all Californians to enroll in the new plan might require federal regulatory changes. Coupled with the big price tag and a lack of a clear funding mechanism, it seems unlikely that the legislation will pass in this season. The effort is, however, another example of people being interested in single-payer health care.

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State efforts to tame drug prices gain traction

by jerry on February 13, 2021

Over the last several years, people have been noticing and becoming vocal about the rapid rise of many drugs. Kaiser Health News reported on various state lawmakers introducing measures to reduce prices (or at least price increases). One state, for example, wants to index prices to those charged in Canada.

Over the last several years, people have been noticing and becoming vocal about the rapid rise of many drugs. Kaiser Health News reported on various state lawmakers introducing measures to reduce prices (or at least price increases). One state, for example, wants to index prices to those charged in Canada.

In the short-term, pharmaceutical companies can fight back through lobbying efforts or threatening to make their products unavailable in certain markets. If the drug prices continue to go unchecked, it seems likely that society will find some sort of solution, either through legislation or through regulation (e.g. allowing importation from Canada).

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How some hospitals bill in cases of accidents

by jerry on February 06, 2021

The New York Times published a troubling article on how some hospitals choose to bill accident victims. Apparently, instead of billing the victims' insurance companies, some hospitals will file a lien on the proceeds from the accident. This practice allows hospitals to charge their full retail price instead of the rates negotiated by insurance companies. Accident victims could be expecting to use the proceeds from the accident for other purposes (e.g. time off of work for recovery). The article describes how some hospitals engage in this practice despite being shown an insurance card by the patient or having patients sign a form upon arrival that commits them to paying out of the accident's settlement.

The New York Times published a troubling article on how some hospitals choose to bill accident victims. Apparently, instead of billing the victims' insurance companies, some hospitals will file a lien on the proceeds from the accident. This practice allows hospitals to charge their full retail price instead of the rates negotiated by insurance companies. Accident victims could be expecting to use the proceeds from the accident for other purposes (e.g. time off of work for recovery). The article describes how some hospitals engage in this practice despite being shown an insurance card by the patient or having patients sign a form upon arrival that commits them to paying out of the accident's settlement.

Hospital spokesmen will defend this practice as simply maximizing their revenue. Yet, especially in cases where the patients shows his or her insurance card and expects his or her insurance to pay, it seems unethical to charge the full retail price. Even showing patients a form to sign upon arrival from an accident without explaining the financial consequences seems dubious. Hospitals who persist in this practice will likely draw the attention of legislators or regulators, similar to how surprise medical billing has garnered enough attention to get banned.

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