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.Got questions?
The New York Times reported that the issue of surprise billing has been getting more attention at the national level. Apparently, California's legislation has garnered much attention. Interestingly, Brookings reported that after California's legislation went into effect, insurance companies' network of physicians increased by about 16%. The theory is that by reducing the attractiveness of remaining out-of-network, more physicians will agree to be in-network. California's legislation achieves this effect by stipulating that insurance plans need only to "pay out-of-network physicians at in-network hospitals the greater of the insurer's local average contracted rate or 125% of the Medicare reimbursement rate."
California's legislation might introduce some interesting quirks. For example, insurance companies now have a much stronger incentive to not contract with the most expensive providers, since removing them from the network would reduce the average for all out-of-network providers. Additionally, instead of paying above-average rates, payers can now just pay average rates when their patients go to that provider (if the payer refused to contract with those most expensive providers). This immediate effect might be the legislation's intention, but the effect might lead to a downward pressure on quality. Suppose, for example, higher quality medicine is more expensive to deliver (a supposition not yet academically proved): in that case, insurers may be tempted to not contract with the expensive providers for a short-term boost of cheaper, higher-quality care. In the long-run, however, such providers might go out of business or might cut back on their quality. A way to balance this would have been to pick a reimbursement percentile higher than 50% (e.g. 65%) of the local average such that insurers have a stronger incentive to negotiate for providers to contract with them. Alternatively, payers might have been able to largely solve this problem by offering higher rates to (or contracting exclusively with) providers who agree to never consult with out-of-network providers (or at least pay for any charge differences) for the insurers' patients (this does not solve the case of when a patient has an emergency and goes to the nearest provider, who is out-of-network). Another reasonable option might have been to limit physician reimbursement to something like 400% of Medicare's reimbursement rate -- in which case insurers would have a strong incentive to negotiate, but have limited prices in the cases of emergencies.
In another sign of changing times, Kaiser Health News published an interesting article about health care being sold on Groupon, a website traditionally oriented around consumer retail experiences (e.g. restaurants). Groupon is known for its heavy discounting, and Groupon keeps a large cut of what it helps sell (around half). Thus, that healthcare institutions have started to make their services available through Groupon suggests that an increasing number of provider organizations are looking for new channels of bringing in revenue.
Interestingly, one provider organization indicated that it started offering its services on Groupon in response to other organizations already doing so. That response suggests that competition is at work. It will likely still be a long time before we see more sophisticated procedures being sold like this (if ever), but that there are some services available through this non-traditional channel suggests that some patients are keen on more affordable health care, and some providers would very much like to provide that.
We recently released some updates to our provider interface. For several years, providers have been able to claim their profiles and update or add information. However, each update required visiting a separate page and then returning to the original profile. Instead, we have made the updates inline so that the update process is more streamlined.
We have other user interface improvements planned or in the pipeline. If you have any feedback, please let us know.
Kaiser Health News published some analysis trying to explain why hospitals may have been able to increase their prices without being nearly as maligned as others in the healthcare industry, notably pharmaceutical and insurance companies. Central to the analysis is that hospitals are local. For example, the author notes "It's easy to get voters riled up about a drugmaker in Silicon Valley or an insurer in Hartford. It's much riskier to try to direct their venom at the place where their children were born, that employed their parents as nurses, doctors and orderlies..." Additionally, hospitals may have been able to avoid some regulatory scrutiny because of their local political clout (with nearly every politician having a major health system in his or her district).
While hospital prices have increased less than many individual drugs (42% from 2007 to 2014), spending at hospitals is the biggest component of the healthcare industry expenditures. With that in mind, perhaps the American public would benefit from smaller but more numerous hospital systems that compete against each other.
For nearly two decades, many in the healthcare industry have held out hope that empowering consumers with sufficient information would exert enough pressure on providers that patients would receive higher-value care. It turns out that even diligent consumers can be frustrated in their efforts to find pricing information. Kaiser Health News reported on one patient who actively sought pricing information before his procedure, but the estimate was more than 50% off.
When estimates can be that far off, it is difficult for shopping around to be meaningful. Ideally, the estimates have to be accurate (i.e. providers cannot charge much more than what was estimated), and estimates would be easy to obtain. Unfortunately, complications do arise, meaning that there can legitimately be variation on the price. Giving consumers a range of prices would be helpful, but not if the ranges are too broad and if the conditions for the upper end of the range are too vague. Health care is complicated, and even just procedure pricing can be difficult to obtain.