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?
In another example of how a good system of incentives can be hard to craft, Kaiser Health News reported on Congress mandating that CMS ease its penalties for hospitals serving low-income patients whose readmission rates are too high. Originally, the policy was to penalize all hospitals whose readmission rates are too high (with the rationale that if a hospital does a sloppy job on a procedure, causing patients to return to the hospital within 30 days, then those hospitals should be paid less). Parts of the medical community argue that low-income patients can easily land back in the hospital for reasons outside of the hospitals' control (such as patient inability to afford medication), thus unfairly penalizing hospitals. Understandably, putting additional financial strain on hospitals that serve low-income patients raises the question of whether those communities will face reduced access (e.g. if some of those hospitals close).
The question in this discussion is one of risk-adjustment (with low-income patients having worse health outcomes on average than higher-income patients). The new policy evaluates each hospital in the context of one of five peer groups. It will be interesting to see how long this framework of five peer groups holds. Perhaps some providers will argue for a rural vs. urban distinction, or ask for some other type of risk-adjustment.
There is a Wall Street Journal article that has been making the rounds on the internet last week. The article cites a few cases where payers (whether large self-insured employers or insurance companies) tried to exclude certain individual providers from some plans and were stymied by the terms of seemingly unrelated contracts. For example, Walmart ask to remove the 5% of providers with the worse quality scores from its networks, and found that it was unable to do so. The article attributes the inability for payers to selectively modify specific networks to the market dominance that health systems often enjoy, allowing them to force clauses that prohibit such modifications. As long as the payers contract with those health systems (and the payers often cannot avoid doing so), the payers are obligated to include all individual clinicians in all plans.
Interestingly, the providers will frame this as consumer choice, saying that patients should have access to the full range of providers within a health system. What that response omits is what happens if patients want to achieve lower monthly premiums by having a restricted network? Where is patient choice in that case?
Dr. Jose Baselga made news recently when media reported that he failed to disclose millions of dollars of income that he had received from companies. As the chief medical officer of a prestigious cancer center, and as a prominent researcher, Dr. Baselga was in the position to influence treatment guidelines.
The New York Times published an opinion piece that explains why conflicts of interest can be detrimental to scientific understanding and the health of society. Apparently, policy changed in the 1980s, opening up opportunities for researchers to earn additional income through royalties, and that policy change has made researchers far more vulnerable to the influence of companies. The opinion piece cited a study that shows that studies whose conclusions about antidepressants were negative often were not published or were spun to convey a more positive outcome. We believe that transparency and disclosure are helpful, although a lack of enforcement might make current policies inadequate.
Healthcare practices in California have been consolidating into fewer and fewer health systems that are larger and larger. Kaiser Health News reported on a study which found that the percentage of physicians that practiced in settings owned by hospitals increased from 24 percent in 2010 to 39 percent in 2016. The effect is more pronounced among the specialists, where the percentage rose from 20 percent to 54 percent over that same time period.
The primary concern about consolidation in any industry is the undermining of competitive dynamics. The article includes a chart which shows that higher concentration of providers is correlated with higher insurance premiums. In areas that are dominated by large networks, insurance companies have a difficult time declining to work with the large networks, which can set higher prices. The article mentions the acquisition of smaller practices by hospitals as a strategy of countering declining inpatient admissions.
NPR reported on a survey showing that most respondents have been surprised by a medical bill that they expected would be paid by insurance. The survey had only 1,002 respondents, but if representative, that would represent a very large number of Americans who have been surprised by medical bills.
Surprise medical bills could happen because a doctor who was thought to be in-network might not have actually been, or an out-of-network provider was involved, or insurance not covering a type of treatment that it was thought to cover, or presumably a host of other reasons. Needless to say, such surprise medical bills make consumer transparency significantly more difficult. For elective or non-urgent procedures, it would be nice if patients could easily call up the provider office and get an accurate quote for how much the services would cost before committing to the procedure. Better yet, it would be even nicer if providers published their prices in machine-readable format (or via a centralized repository) so that consumers could easily compare prices.