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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.

Oklahoma approves Medicaid expansion

by jerry on July 05, 2020

Associated Press reports that Oklahoma approved Medicaid expansion, which means that the state government will subsidize health insurance so that more people will be able to afford it. This decision by voters contrasts with the state's earlier persistent refusal. Interestingly, the article notes that this decision was done through a constitutional amendment, meaning that the state legislature by itself would not able to overturn the decision in the future.

Associated Press reports that Oklahoma approved Medicaid expansion, which means that the state government will subsidize health insurance so that more people will be able to afford it. This decision by voters contrasts with the state's earlier persistent refusal. Interestingly, the article notes that this decision was done through a constitutional amendment, meaning that the state legislature by itself would not able to overturn the decision in the future.

The passage of the Affordable Care Act (ACA) was controversial, and opponents have challenged various parts of it. One controversial aspect of the bill was whether or not to expand Medicaid coverage so that more people who could not afford health insurance would be able to get it through Medicaid (known as Medicaid expansion). The Affordable Care Act had the federal government initially pay for much or all of the additional cost, but then after a period of several years, states would be liable. Several states balked at the prospect of having to pay more to subsidize health coverage. Over time, the opposition to the Affordable Care Act has eroded some, although there is still an ongoing court case to overturn it completely. It could be that as more people have experienced having health insurance, more people have been feeling that everyone should be able to have it.

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Tentative victory for procedure pricing transparency

by jerry on June 27, 2020

In a tentative victory for healthcare pricing transparency, Reuters reported that a federal judge dismissed a challenge filed by American Hospital Association (AHA) against the current administration's requirement that hospitals publicly disclose procedure pricing. The requirements came out as a proposal last year, and industry expected the requirements to be challenged. AHA plans on appealing the decision, so the ruling might not be final.

In a tentative victory for healthcare pricing transparency, Reuters reported that a federal judge dismissed a challenge filed by American Hospital Association (AHA) against the current administration's requirement that hospitals publicly disclose procedure pricing. The requirements came out as a proposal last year, and industry expected the requirements to be challenged. AHA plans on appealing the decision, so the ruling might not be final.

Reuters reported that AHA claimed that the disclosure requirements would undermine competition. It is difficult to understand that claim. The AHA made other claims (such as hospitals "resources are stretched thin and need to be devoted to patient care," similar to what the cell phone service providers claimed when forced to support phone number portability), but this particular claim of undermining competition seems far-fetched. Reuters also notes that hospital groups claimed that requiring disclosure of negotiated charges "would create confusion about patients' out-of-pocket costs, not prevent it" -- a claim that appears rather condescending. While disclosure of the prices may indeed be confusing, it at least provides a starting point with actual data. The status quo generally involves phone calls to confused hospital phone operators who might or might not be able to answer the question of pricing.

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Sutter tries to renegotiate settlement

by jerry on June 20, 2020

Following up on news that they reported late last year, Kaiser Health News recently reported on Sutter Health, a large medical system in Northern California, which now seeks to reduce the terms of its settlement. Sutter was accused of anticompetitive behavior and of being responsible for higher prices in their area.

Following up on news that they reported late last year, Kaiser Health News recently reported on Sutter Health, a large medical system in Northern California, which now seeks to reduce the terms of its settlement. Sutter was accused of anticompetitive behavior and of being responsible for higher prices in their area.

This article relayed that Sutter is asking for the terms of the settlement to be reduced given the financial hardships imposed by the pandemic. The argument that Sutter seems to be making is that they are operating at such a loss that the terms of the settlement (agreed upon before the pandemic), would force them to compromise the quality and/or extent of care they can provide. Apparently, Sutter not only objects to the size of the financial settlement, but also wants to roll back some of the other parts of the agreement, including forcing payers to accept their entire network (or none at all) and limiting rate increases. Clearly, there is a lot at stake financially for Sutter, but the attempt to renegotiate the non-financial terms raises questions around the extent to which Sutter is trying to capitalize on the current circumstances.

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Some practices dropping Medicare

by jerry on June 14, 2020

In economics, there is supply and there is demand. When growth in demand outstrips growth in supply, prices increase. When a price ceiling is put in place to restrain prices, the market usually encounters a situation where not everyone who can afford to buy can actually do so. Kaiser Health News reported on the general shortage of primary care doctors in the US, with an emphasis on Medicare patients' inability to find doctors. Medicare, while heralded as a success for elderly patients, typically pays less than commercial payers. Up until somewhat recently, many practices had to accept Medicare simply because of the number of Medicare patients. With supply not being able to keep up with demand, some practices have made business decisions to not accept Medicare patients.

In economics, there is supply and there is demand. When growth in demand outstrips growth in supply, prices increase. When a price ceiling is put in place to restrain prices, the market usually encounters a situation where not everyone who can afford to buy can actually do so. Kaiser Health News reported on the general shortage of primary care doctors in the US, with an emphasis on Medicare patients' inability to find doctors. Medicare, while heralded as a success for elderly patients, typically pays less than commercial payers. Up until somewhat recently, many practices had to accept Medicare simply because of the number of Medicare patients. With supply not being able to keep up with demand, some practices have made business decisions to not accept Medicare patients.

Some people have tried to portray greedy doctors as being the reason for the difficultly that Medicare patients have when searching for a new doctor. In reality, if commercial insurers pay significantly more than Medicare does, it can often be a very difficult business decision to continue to accept Medicare, especially when the average salary of primary care doctors is only about 80% of the average salary across all specialties (per the article). A more systematic fix would be to allow prices to adjust annually, allowing the under-compensated specialties to be paid more and hopefully drawing more doctors into the field (thus increasing supply).

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Battling against healthcare consolidation

by jerry on June 06, 2020

Kaiser Health News published a piece on California's current Attorney General's battle against consolidation in the healthcare industry. Even before the pandemic, Northern California had already seen a lot of consolidation among its providers (clinics and health systems). The article reports that the pandemic has only accelerated the trend of consolidation as physician practices have seen very light patient volume. The article also referenced a Health Affairs article, indicating that "In 2010, about 25% of California physicians worked in a practice owned by a hospital. By 2016, more than 40% of doctors worked in hospital-owned practices."

Kaiser Health News published a piece on California's current Attorney General's battle against consolidation in the healthcare industry. Even before the pandemic, Northern California had already seen a lot of consolidation among its providers (clinics and health systems). The article reports that the pandemic has only accelerated the trend of consolidation as physician practices have seen very light patient volume. The article also referenced a Health Affairs article, indicating that "In 2010, about 25% of California physicians worked in a practice owned by a hospital. By 2016, more than 40% of doctors worked in hospital-owned practices."

Consolidation reduces competition, which ends up giving more power to the suppliers over the purchasers. The California Medical Association opposed a bill to grant the attorney general more tools to stop mergers, saying that the legislation, as written, is too broad and would including leasing and other contracting arrangements and also does not provide for a meaningful channel to appeal decisions. It is likely that the California Medical Association has good points here, as writing good laws can be very difficult.

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