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Despite recent legislation to prevent surprise billing in the form of out-of-network providers, KFF Health News described another way that some physicians can surprise their patients with bills. Apparently, some physicians have started classifying certain "procedures" as surgery, despite those procedures being as removing a splinter. Classifying procedures as such allows physicians to bill more, and if a patient has not met the deductible, the patient may be the one paying. It seems that in many cases, when doctors are about to perform a procedure that will add an additional charge -- especially an unexpected one -- they should inform patients about the extra charge. For example, when a customer is having his car serviced in a repair shop, the mechanic generally recommends procedures, and the customer can decide which of the recommendations to pay for -- before the mechanic performs the procedures.

Despite recent legislation to prevent surprise billing in the form of out-of-network providers, KFF Health News described another way that some physicians can surprise their patients with bills. Apparently, some physicians have started classifying certain "procedures" as surgery, despite those procedures being as removing a splinter. Classifying procedures as such allows physicians to bill more, and if a patient has not met the deductible, the patient may be the one paying. It seems that in many cases, when doctors are about to perform a procedure that will add an additional charge -- especially an unexpected one -- they should inform patients about the extra charge. For example, when a customer is having his car serviced in a repair shop, the mechanic generally recommends procedures, and the customer can decide which of the recommendations to pay for -- before the mechanic performs the procedures.

The article discussed some of the motivation behind this new practice. For a few decades now, physician compensation has been largely influenced by a committee that helps determine the relative value of different procedures (such as an office visit versus a wart removal), and the article explains that "Since surgeons are overrepresented on the committee, the valuation of anything defined as an operation has only increased, giving billers the incentive to classify even the most mundane interventions as surgery." It is not surprising that providers want to be paid more, but this method of classifying simple treatments as surgeries would likely be a surprise to many inside and outside the medical community.

Sometimes, professional medical organizations will declare that anyone who has fulfilled the necessary steps to secure a medical degree (and perhaps obtained certification) is adequately competent to treat patients. Yet, providers can vary in their judgements and skills, sometimes leading to very different patient health outcomes. KFF Health News published a piece that opens with a patient who received very different treatments from different providers. One provider apparently said that the patient should not be expected to recover from a heart attack, while another successfully treated the same patient, giving him enough time for a heart transplant. More generally, the article is about the inadequacies of one health system (where the first provider worked), which could become complacent after it formed from a merger, because it became the sole health system in a large area.

Sometimes, professional medical organizations will declare that anyone who has fulfilled the necessary steps to secure a medical degree (and perhaps obtained certification) is adequately competent to treat patients. Yet, providers can vary in their judgements and skills, sometimes leading to very different patient health outcomes. KFF Health News published a piece that opens with a patient who received very different treatments from different providers. One provider apparently said that the patient should not be expected to recover from a heart attack, while another successfully treated the same patient, giving him enough time for a heart transplant. More generally, the article is about the inadequacies of one health system (where the first provider worked), which could become complacent after it formed from a merger, because it became the sole health system in a large area.

Part of the challenge is that while some people are privy to the internal benchmarks, quality reports are not made publicly available. The CEO of the health system has strong relationships with state and local officials, who support the health system and may be suppressing quality issues. Essentially, both the health system and some government officials ask for the trust of the public that the health system is performing adequately. Meanwhile, people who are familiar with healthcare quality have raised concerns, echoing concerns from local medical professionals. Cases like this illustrate why releasing quality reports to the general public can be helpful to individuals who, as described in the article, might actually move out of the area for better health care.

Happy Thanksgiving!

Happy Thanksgiving!

Many people believe that investing in primary care can curtail the need for specialty care, with the thought that primary care can identify and treat many issues early on, when such treatment is less expensive. At the same time, compensation in the medical field tends to reward specialists. KFF Health news reports that the California agency tasked with slowing healthcare spending appears to be trying to rectify the situation by setting a goal for insurers to spend 15% of their budgets on primary care (up from the current 7%). At this point, there does not seem to be much incentive in place, with the possible exception that the agency might exempt insurers from a previously set annual limit of 3.5% for growth in healthcare spending.

Many people believe that investing in primary care can curtail the need for specialty care, with the thought that primary care can identify and treat many issues early on, when such treatment is less expensive. At the same time, compensation in the medical field tends to reward specialists. KFF Health news reports that the California agency tasked with slowing healthcare spending appears to be trying to rectify the situation by setting a goal for insurers to spend 15% of their budgets on primary care (up from the current 7%). At this point, there does not seem to be much incentive in place, with the possible exception that the agency might exempt insurers from a previously set annual limit of 3.5% for growth in healthcare spending.

The purported timeline is ten years, which seems ambitious given that "The agency said it will begin to collect primary care spending data in fall 2025, but that information may not be released for two more years." If insurers are unable to negotiate better prices for specialty care, it would be ironic if the growth in healthcare spending accelerates because insurers try to spend more on primary care to comply with this goal.

KFF Health News reported on a practice where some obstetrics practices will ask patients to prepay for care. One of the nuances is that providers bundle the billing for prenatal care, labor, and delivery, meaning that the final bill does not get settled until after the baby is born and that the bill tends to be larger because so many services are bundled. It appears that this practice grew out of concern for maternal health when people observed that some mothers skipped important care during pregnancy in order to avoid paying co-pays.

KFF Health News reported on a practice where some obstetrics practices will ask patients to prepay for care. One of the nuances is that providers bundle the billing for prenatal care, labor, and delivery, meaning that the final bill does not get settled until after the baby is born and that the bill tends to be larger because so many services are bundled. It appears that this practice grew out of concern for maternal health when people observed that some mothers skipped important care during pregnancy in order to avoid paying co-pays.

Understandably, providers want to ensure that they are paid for their services, and arranging prepayment helps ensure that. It is also understandable why patients might be upset at being asked for prepayment. Among other reasons, asking for prepayment implies some doubt that the patient will pay what is due.