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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.

Supreme Court uploads the ACA again

by jerry on June 20, 2021

The Supreme Court of the United States heard a third challenge to the constitutionality of the Affordable Care Act (ACA), and in a 7-2 decision, decided to dismiss the legal arguments on the basis of a lack of standing, or the ability to show that the plaintiffs were actually or were about to be harmed. The first challenge to the ACA that went to the Supreme Court was one of overreach: that the federal government lacked constitutional authority to require citizens to purchase health insurance (known as the individual mandate, to be enforced with a fine administered through tax filings). In that case, the Supreme Court decided that the individual mandate was actually a tax, which Congress is allowed to levy (never mind that some proponents of the ACA specifically said that the individual mandate was not a tax). The crux of the second challenge to the ACA that the Supreme Court heard rested on whether "State" only meant a state (like California), or if it could mean the federal government; the Supreme Court decided on the expanded meaning. Between the first challenge and the most recent challenge, a Republican-controlled Congress legislated that the fine for the individual mandate would be set to zero. The third challenge then refers back to the first challenge: if there is no tax, does the federal government have the authority to pass the ACA, requiring individuals to buy insurance? Interestingly, the court majority decided that the plaintiffs lacked standing, thereby dismissing the case. The dissenting justices provided examples in which they believed the plaintiffs would indeed be harmed by the ACA, as well as cases in which plaintiffs had a more tenuous connection to harm and yet were allowed to sue.

The Supreme Court of the United States heard a third challenge to the constitutionality of the Affordable Care Act (ACA), and in a 7-2 decision, decided to dismiss the legal arguments on the basis of a lack of standing, or the ability to show that the plaintiffs were actually or were about to be harmed. The first challenge to the ACA that went to the Supreme Court was one of overreach: that the federal government lacked constitutional authority to require citizens to purchase health insurance (known as the individual mandate, to be enforced with a fine administered through tax filings). In that case, the Supreme Court decided that the individual mandate was actually a tax, which Congress is allowed to levy (never mind that some proponents of the ACA specifically said that the individual mandate was not a tax). The crux of the second challenge to the ACA that the Supreme Court heard rested on whether "State" only meant a state (like California), or if it could mean the federal government; the Supreme Court decided on the expanded meaning. Between the first challenge and the most recent challenge, a Republican-controlled Congress legislated that the fine for the individual mandate would be set to zero. The third challenge then refers back to the first challenge: if there is no tax, does the federal government have the authority to pass the ACA, requiring individuals to buy insurance? Interestingly, the court majority decided that the plaintiffs lacked standing, thereby dismissing the case. The dissenting justices provided examples in which they believed the plaintiffs would indeed be harmed by the ACA, as well as cases in which plaintiffs had a more tenuous connection to harm and yet were allowed to sue.

It appears that the majority justices would allow unconstitutional laws to remain in place, as long as there was no penalty. To someone outside the legal profession like me, this allowance seems to place an uneven burden on citizens who wish to be law-abiding even if enforcement is not relevant. The majority's opinion also delays clarity on the merits of the case, allowing for potentially unconstitutional laws to remain in effect until harm can be proved and someone affected sues and that plaintiff is successful in reaching the Supreme Court (which is never guaranteed).

I have read elsewhere that this was probably the best result for both political parties. Portions of the ACA have become popular, and if Republicans are known to dismantle the legislation, they might encounter difficulty getting re-elected. Politics can be messy.

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Interest grows in enhancing primary care

by jerry on June 13, 2021

Kaiser Health News reported on the growth of various efforts to extend primary care and make it more accessible to patients. There appear to be a growing number of healthcare provider groups that charge an access fee (one firm currently charges $199/year) and in return, promise better service, including more availability and more timely appointments. These provider groups sometimes target larger employers by offering onsite clinics.

Kaiser Health News reported on the growth of various efforts to extend primary care and make it more accessible to patients. There appear to be a growing number of healthcare provider groups that charge an access fee (one firm currently charges $199/year) and in return, promise better service, including more availability and more timely appointments. These provider groups sometimes target larger employers by offering onsite clinics.

The article cited an interesting study showing that one employer, SpaceX, benefited from lower overall healthcare costs, even though spending on primary care was higher than others. There is a general sentiment that US under-invests in primary care by paying specialists more, luring more people who are training to be doctors to become specialists. There does not seem to be strong indication that insurance companies are about to change their reimbursement policy significantly for doctors remaining on fee-for-service, and it is interesting that some employers are experimenting with this approach. Insurers are, however, looking at value-based compensation policies, which might have similar effects. Much more data will need to be collected to see if any of these approaches meaningfully slows the growth in healthcare costs.

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A problem with online reviews

by jerry on June 06, 2021

The Washington Post published an article that is critical of online reviews, starting with an account of one couple's reliance on online reviews in selecting an addiction treatment facility which proved ineffective in stopping a drinking addiction. The article outlines some strategies that technology firms might employ to try to detect fraudulent reviews. The article also discusses one woman's journey into combating fake reviews and discovering dozens of Facebook groups where businesses trade reviews. Notably, fake reviews are not specific to the medical field; it is a problem that can plague items such as books and household goods, and even the concept of verified reviews can be gamed.

The Washington Post published an article that is critical of online reviews, starting with an account of one couple's reliance on online reviews in selecting an addiction treatment facility which proved ineffective in stopping a drinking addiction. The article outlines some strategies that technology firms might employ to try to detect fraudulent reviews. The article also discusses one woman's journey into combating fake reviews and discovering dozens of Facebook groups where businesses trade reviews. Notably, fake reviews are not specific to the medical field; it is a problem that can plague items such as books and household goods, and even the concept of verified reviews can be gamed.

The article does highlight what might be the root of the problem: "And in the absence of reliable and easily accessible information about doctor performance, most patients are going to continue to resort to online reviews, Yaraghi, the Miami professor, said." The medical community has seen many internal disagreements about how to measure quality, but also seems to be reluctant resolve those disagreements. In the absence of benchmarks from the industry, the question is whether these online reviews are -- on average -- helpful or not. My feeling is that online reviews (not just for doctors) are generally helpful, but they should only be considered as one component of a person's decision process.

One commenter on the article noted: "Part of the problem is that there is virtually no information about doctors out there other than their speciality [sic] and where they got their degree. Occasionally you can get where they did their residency and internship. ... So, where do you turn? Reviews posted on the internet are about the only thing out there." One commentator's solution? "Doctors should really start soliciting reviews from every single patient they treat. Yes a small minority might post negative reviews, but the vast majority will post positive ones that will outweigh the negative ones."

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Colorado considers drug pricing review board

by jerry on May 30, 2021

Kaiser Health News reported on Colorado's efforts to rein in drug prices. In addition to wanting to import drugs from Canada, the state legislature is considering a "prescription drug affordability board." Apparently, the board would be permitted to set price limits for up to twelve drugs annually, but could recommend other courses of actions.

Kaiser Health News reported on Colorado's efforts to rein in drug prices. In addition to wanting to import drugs from Canada, the state legislature is considering a "prescription drug affordability board." Apparently, the board would be permitted to set price limits for up to twelve drugs annually, but could recommend other courses of actions.

While the legislation has not yet been signed into law, the pharmaceutical industry has opposed it. It seems a little unclear to me whether such a law would pass constitutional challenges, but that this legislation has the backing that it has suggests that the public is wary of high drug prices and is willing to consider legislative and regulatory actions.

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Patients now entitled to free access to their medical records

by jerry on May 23, 2021

Reporting on news that some people have been waiting on for a while, Kaiser Health News published a piece on a federal rule that recently took effect: healthcare providers are now required to provide patients with electronic access to their health information "without delay upon request, at no cost." It might seem odd that federal intervention is required for patients to have access to their health records -- it is, after all, their health -- but attitudes were very different even just fifteen years ago.

Reporting on news that some people have been waiting on for a while, Kaiser Health News published a piece on a federal rule that recently took effect: healthcare providers are now required to provide patients with electronic access to their health information "without delay upon request, at no cost." It might seem odd that federal intervention is required for patients to have access to their health records -- it is, after all, their health -- but attitudes were very different even just fifteen years ago.

The article notes benefits of patients reading doctor notes: understanding more about their condition, remembering their treatment plan, being more likely to comply with prescriptions. Non-white, less educated, and older patients appear to benefit more than others, perhaps suggesting that the availability of notes allows those patients to better overcome potential language barriers (for example) because they have information to refer to after their visits.

Despite these benefits, many in the medical community at one point objected to openly sharing medical records with patients. Perhaps some felt that patients might needlessly question their notes or misinterpret some concept. Hopefully, the effect of this regulation will be to further cement a cultural shift among healthcare providers towards transparency.

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