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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.

Doctors lobbying for their interests

by jerry on February 16, 2020

Kaiser Health News published another article in the fight over surprise medical billing, where a patient thinks that s/he is receiving in-network services but is billed at out-of-network rates. Patient frustration with being stuck with large surprise medical bills has mounted enough that legislatures (both state and federal) have considered a variety of bills to address the issue. Now, however, some doctors are lobbying to have such legislation incorporate terms that are more favorable to physicians.

Kaiser Health News published another article in the fight over surprise medical billing, where a patient thinks that s/he is receiving in-network services but is billed at out-of-network rates. Patient frustration with being stuck with large surprise medical bills has mounted enough that legislatures (both state and federal) have considered a variety of bills to address the issue. Now, however, some doctors are lobbying to have such legislation incorporate terms that are more favorable to physicians.

Perhaps not surprising, Kaiser Health News reported that physician organizations that have heavily lobbied for changes in surprise medical bills are related to specialties where the context is time-sensitive (e.g. emergency medicine, anesthesia) -- those specialties probably have a number of physicians that benefit financially from the current confusion.

Surprise medical billing seems like a mostly solvable problem. For example, insurers could require that all services rendered at an in-network facility are billed at in-network rates, thereby pushing the problem to the facility to coordinate and recruit physicians that accept the same insurance plans. In turn, insurers might pay extra for imposing that condition, but their members would be much less likely to be stuck with what they consider an outrageous bill. If this conflict keeps simmering, I expect there to be additional legislative efforts to be considered.

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Retroactively requiring pre-authorization

by jerry on February 09, 2020

The provider practice of surprise billing has made the news over the last few years. Kaiser Health News reports on a practice of insurance companies that I have not heard of before: retrospectively requiring pre-authorization. The practice of pre-authorization is commonplace and the intention is to help ensure that providers do not get too carried away and perform medically unnecessary tests and procedures. However, it appears that some insurers are not clear which procedures require pre-authorization and perhaps go as far as indicating that a patient does not need pre-authorization and then reverse their positions. Even worse is indicating to a patient that a procedure is pre-authorized and then denying payment for the procedure as "medically unnecessary" (Kaiser Health News notes footnotes on pre-authorizations to the effect of "This is not a guarantee of payment"). Obviously, this can cause financial and emotional hardship for patients who think they are abiding by the insurers' policies.

The provider practice of surprise billing has made the news over the last few years. Kaiser Health News reports on a practice of insurance companies that I have not heard of before: retrospectively requiring pre-authorization. The practice of pre-authorization is commonplace and the intention is to help ensure that providers do not get too carried away and perform medically unnecessary tests and procedures. However, it appears that some insurers are not clear which procedures require pre-authorization and perhaps go as far as indicating that a patient does not need pre-authorization and then reverse their positions. Even worse is indicating to a patient that a procedure is pre-authorized and then denying payment for the procedure as "medically unnecessary" (Kaiser Health News notes footnotes on pre-authorizations to the effect of "This is not a guarantee of payment"). Obviously, this can cause financial and emotional hardship for patients who think they are abiding by the insurers' policies.

It is unclear how common this practice is compared to before, but this issue might gain more news coverage. If the industry is unable to resolve the issue in a reasonable manner, people will look to the government to intervene, similar to how laws against surprise medical billing have been enacted.

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Analysis on presidential power to reduce drug pricing

by jerry on January 31, 2020

Kaiser Health News published a piece investigating whether a president can meaningfully reduce drug prices without legislative action (as proposed by Senator Warren). Surprisingly (to me at least), the analysis is in the affirmative. The piece talked about the powers of Section 1498, which apparently allows the government to "take over patents" if the price is deemed too high. This law has been used before, and has also been used by the Department Of Defense for non-medicinal purposes. While this law is not meant to be applied broadly, it could address the cost of some popular drugs.

Kaiser Health News published a piece investigating whether a president can meaningfully reduce drug prices without legislative action (as proposed by Senator Warren). Surprisingly (to me at least), the analysis is in the affirmative. The piece talked about the powers of Section 1498, which apparently allows the government to "take over patents" if the price is deemed too high. This law has been used before, and has also been used by the Department Of Defense for non-medicinal purposes. While this law is not meant to be applied broadly, it could address the cost of some popular drugs.

Clearly, use of this law would be controversial and would draw sharp criticism from the pharmaceutical industry. However, as Americans' frustration with rising healthcare costs continues to mount, politicians will be looking at more alternatives.

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California tries to rein in healthcare costs

by jerry on January 26, 2020

Kaiser Health News published a summary of legislative efforts in California to curb healthcare costs. One big idea is for the state to create its own private label and sell specific generics. Commentators seem to agree that this is unlikely to save the state substantial amounts of money, but might make a big different to individuals. Apparently, there is a bigger proposal underway in terms of creating a single drug market.

Kaiser Health News published a summary of legislative efforts in California to curb healthcare costs. One big idea is for the state to create its own private label and sell specific generics. Commentators seem to agree that this is unlikely to save the state substantial amounts of money, but might make a big different to individuals. Apparently, there is a bigger proposal underway in terms of creating a single drug market.

It's too early to tell whether these measures will actually come to fruition, and if so, whether they will be effective, and what side effects they will entail. However, if these efforts are successful, perhaps other states (and the federal government) would consider adopting similar measures.

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The price of an appendectomy

by jerry on January 18, 2020

The Washington Post published an opinion piece in which the author recounted her experience of receiving an emergency appendectomy. Unfortunately, she chose to go to a nearby hospital instead of one that was in her insurance's network. Consequently, she had a much larger bill to contend with.

The Washington Post published an opinion piece in which the author recounted her experience of receiving an emergency appendectomy. Unfortunately, she chose to go to a nearby hospital instead of one that was in her insurance's network. Consequently, she had a much larger bill to contend with.

The emergency nature of the procedure limited the author's options. What's surprising is the detail that the surgeon asked for the author's profession (and that of her husband) before announcing the price of the procedure. In other industries, variable pricing is allowed (e.g. the price one might be offered at a car dealership could depend on a variety of factors). In the context of emergency procedures, however, stories like this add fuel to a growing discontent with the healthcare industry. Much as there has been momentum against balance billing, I suspect that people will also push for pricing reform within healthcare.

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