Bizarre defense against runaway prices
May 16, 2015
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.
May 16, 2015
Kaiser Health News profiled a small benefits consulting firm which advises its clients to not contract with local providers, and to simply not pay the billed amount. On one hand, since an individual agreed to be treated by the provider, either the individual or the relevant insurer would be liable for whatever the provider charged. That's one of the usual motivations for insurers to contract with providers (to limit their financial exposure). On the other hand, the billed amount is frequently understood as unreasonable by both industry insiders and outside observers. The actual amount that is agreed upon by providers and insurance companies (called the "allowable amount") is often a small fraction of the "list" price (also known as the chargemaster price). Surprisingly, a judge in Georgia ruled in favor of the benefits consulting firm.
Not being a lawyer, the legal arguments of the decision were a bit difficult to follow. However, the heart of the ruling seems to revolve around what is considered reasonable. It seems that since providers frequently accept much lower rates for Medicare patients, the chargemaster price can be considered unreasonable. This approach seems risky and bizarre and I'm curious as to how well this approach will hold up in other cases and in other states. Despite the legal victory, it seems that it would still be unpleasant to be a patient (who gets notified of the responsibility to pay the remainder of a large bill, and have to wait for other companies to fight it out).
It is unfortunate that the industry has evolved to such a point that even determining the amount owed is so difficult to assess. But, then again, as the consulting firm points out: "How can employee-patients consent to prices they will never see until after they've been discharged?" The dramatic rise in healthcare prices has been forcing a number of these types of conversations. Hopefully, the industry will evolve to a point where tensions like these can be resolved in a more constructive manner.
May 10, 2015
Provider directories are notorious for being inaccurate and out-of-date. Part of the issue is that insurance companies generally face little (if any) penalty for incorrect information. Meanwhile, patients (the insurance companies' customers) can suffer financial consequences when they consult a doctor who is listed as being in-network, but actually isn't. Ironically, insurance companies often tell patients to consult with the doctors to make sure that the doctors indeed accept the insurance plan in question; the doctors instruct patients the opposite. Fortunately, this longstanding problem is receiving some attention from federal officials.
It's unclear how vigorously the new standards will be enforced. The standard of "adversely affected" seems fairly vague, and it's unclear how officials will look for people who are affected.
May 03, 2015
CMS has released prescriber data, identifying individual physicians and detailing which prescriptions they wrote for Medicare patients in 2013. This is certainly a welcome step towards transparency -- it's great that the general public now has access to this data.
We're not quite sure how this data can be used to help people select personal physicians. Obviously, though, this data can be used for other applications (such as fraud detection). We'll give some thought as to whether this can be useful to patients; if you have any ideas for how to use this data, please let us know.
April 24, 2015
As complex as it is to get pricing information about medical procedures (did you want the chargemaster price? the in-network price? the price including the facility fee?), pricing data has becoming increasingly available to consumers over the last several years. Quality information, however, remains elusive. In large part, this lack of information is because even within the medical community, physicians disagree on how to measure quality. A cynic might add that even if they did agree, physicians generally would not want that information to be made public. On this front, CMS has laid out five principles regarding quality measurement among physicians. Two of them are: "Feedback and data drives rapid cycle quality improvement. Public reporting provides meaningful, transparent, and actionable information."
Both of these principles are important. Without feedback, people have a much harder time figuring out how to improve. Without public reporting of quality information, consumers will have a hard time meaningfully selecting a physician. Unfortunately, it will take years to see if CMS is able to get the medical community to agree on meaningful measures to track and disclose -- the announcement itself emphasized that the vision is for the "long-term," and that the challenges are expected to span "the next several years." Nevertheless, the public affirmation of these principles within the practice of medicine is encouraging.
April 19, 2015
We continue to refine our website interface. This weekend, we released some changes to make the related searches section at the bottom of the page easier to understand. The related searches section is meant to help the user navigate to other related searches. For example, someone searching for MRI might want to see radiologists (since those specialists interpret MRIs). We used to simply list all of the related searches in one list, which could get rather long. After some internal deliberation, we decided to break up the list by category. For example, if you were to search for "MRI" now, we would show one section of related MRI procedures, and another section for related specialties.
There are many other areas of the user interface that we would like to refine. If you have suggestions, please let us know.