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?
Kaiser Health News published a story about medical tourism, where a patient flew to a foreign country to receive care. In this case, the US-based patient was covered by health insurance in the US, and the insurer even paid the patient $5,000 in addition to covering all related expenses (including travel). This piece highlighted the role of a for-profit company that arranged for a US-trained physician to fly down to Mexico to perform the knee replacement surgery.
In this case, the surgeon made more money for the procedure than usual, the patient did not have to pay co-pays but instead was paid an incentive, the coordinating company made money, and the payer (the self-insured employer) still saved money. The biggest difference in cost is that the facility in Mexico was paid much less than a comparable hospital in the US would have been paid. As healthcare costs continue to rise, people (whether patients, insurers, or others) will continue to look for creative solutions, similar to how others are looking into the feasibility of importing drugs from foreign countries.
Kaiser Health News reported on the government of California adopting policies to help promote more engagement by health insurers. For one, it has offered state-level subsidies (in addition to the federal subsidies) so that more people would find health insurance premiums affordable. The success of insurance plans depend on pools large enough so that the premiums from the policyholders that do not need payouts cover the payouts of the policyholders that do. When premiums are too expensive, healthy individuals might drop out, forcing insurance companies to raise premiums, which in turn causes more people to drop out. California has also adopted a financial penalty to those who opt out of health coverage. Such a penalty was part of the original Affordable Care Act, but was later cancelled.
Interestingly, the executive director of California's ACA health exchange said that nearly 90% of Californians will have three or more carriers to choose from in 2020; apparently three options is a minimum threshold for meaningful competition. Other states also appear to be experiencing healthier exchanges as well.
Following up on an executive order signed earlier in the year, Kaiser Health News recently reported on a proposed rule by the Centers for Medicare & Medicaid Services (CMS, also known as Medicare) that hospitals disclose prices for common procedures (mandated last year), including negotiated prices (new). The proposed rule requires "payer-specific negotiated charges" so a procedure should have multiple prices listed (one for the cash rate, and one per insurer). We are pleased that CMS is proposing that the prices are to be published in a machine-readable format, which should make it easier for websites to incorporate the data. Even more powerful would be if this regulation applied to clinics as well, where a number of outpatient procedures may occur.
Understandably, the American Hospital Association was not happy about the proposal. Interestingly, America's Health Insurance Plans was also against the proposal, suggesting that insurers feel confident about the effectiveness of their negotiations. If this proposal goes through (legal action to prevent it is expected), I think we will find that some insurers had been more successful than others in negotiating prices.
Dr. Ezekiel Emanuel, frequently consulted as an expert on health policy, wrote an opinion piece in the New York Times outlining four suggestions to make health care more affordable. The piece starts out by framing the Democratic presidential candidates as debating the wrong question (what type of national healthcare plan should US adopt versus how do we get healthcare expenses under control). A surprising statistic is that while the US has about 4 percent of the world's population, it accounts for nearly half of the global drug spending. The US has been paying more per dose of medication than others around the world, effectively subsidizing the world's research and development of medication.
Dr. Emanuel takes aim at all the major players in the healthcare industry with a variety of ideas: national negotiations to curb drug pricing, a cap on hospital prices (he blames mergers of hospital systems as the root of soaring prices), and standardization in the insurance industry. Taken as a whole, the healthcare industry is surely not happy about his proposals; taken separately, different parts of the industry might be thrilled at different proposals. Dr. Emanuel lists a fourth option which has been gaining momentum over the last decade: shifting away from fee-for-service compensation for doctors and moving towards value-based payments (in other words, paying for patients' health and good outcomes, rather than paying for amount of work done). These are all sweeping changes that Dr. Emanuel groups as "four simple policies."
Starting in 2014, we integrated procedure information from Medicare. Procedure volume can be a crude but helpful proxy for many surgeries, with research showing that surgeons who have experience performing a procedure often have better outcomes for the procedure. Likewise, patients who need to pay out-of-pocket or who have a high-deductible might be interested in estimates of what a provider might charge. Medicare provides average price submitted by providers for a variety of procedures. To get a sense of how this looks on the search results page, try searching for a procedure like "hip replacement" or "x-ray" in a major city.
Over the last eighteen months, we have re-worked how we stored the data, and for several months, had removed the procedure information from the search results page during the transition. We are pleased to announce that the procedure information is now available on the search results page again, with the ability to sort by procedure volume or price.