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Kaiser Health News reported on a patient who was informed that she would be billed for a facility fee after she opted for a telehealth visit. Hospitals have argued that they should get to charge more because it is expensive to maintain emergency services that might not be used. However, the facility fee has come under additional scrutiny when hospitals have acquired physician practices and charged facility fees when such practices did not charge them before. Applying facility fees to telehealth visits (which need not be done from hospitals) raises the level of controversy.

Kaiser Health News reported on a patient who was informed that she would be billed for a facility fee after she opted for a telehealth visit. Hospitals have argued that they should get to charge more because it is expensive to maintain emergency services that might not be used. However, the facility fee has come under additional scrutiny when hospitals have acquired physician practices and charged facility fees when such practices did not charge them before. Applying facility fees to telehealth visits (which need not be done from hospitals) raises the level of controversy.

An executive at the health system that the patient made an appointment with argued that applying facility fees to telehealth visits would be justified because they still need to maintain their services. (The executive also said that the facility fees offsets the cost of the software for telehealth visits, but smaller physician practices would also need to incur such costs, so that would not be a reason that hospitals exclusively should be entitled to a facility fee.) Hospitals would likely point out that especially given the pandemic, their mix of telehealth visits compared to in-person visits has changed drastically.

However, allowing hospitals to charge an additional facility fee for services that do not actually use the facility seem to privilege them over their non-hospital competitors. A negative consequence is that doing so would likely encourage industry consolidation (such as the purchasing of smaller practices), which tends to lead to higher prices. A fairer approach might be to pay the hospitals a fixed amount for being available to provide emergency services, or only allowing hospitals to charge a facility fee for emergency services.

Although we don't always announce new features, we have been working on a number of different facets of helping people find appropriate care. Frequently, improvements will be in indexing more sources or streamlining operations. This year, we have been working on better contextualizing procedure volume information from Medicare, and we just released the feature earlier this week. Procedure volume is sometimes used as a proxy for quality for some surgeries, with the thought that more experience means better performance.

Although we don't always announce new features, we have been working on a number of different facets of helping people find appropriate care. Frequently, improvements will be in indexing more sources or streamlining operations. This year, we have been working on better contextualizing procedure volume information from Medicare, and we just released the feature earlier this week. Procedure volume is sometimes used as a proxy for quality for some surgeries, with the thought that more experience means better performance.

On the Pricing tab, we try to highlight procedures that providers have performed on many Medicare patients relative to other providers in the same specialty in the same state. Providers that have performed (by volume) in the top 5%, 10%, or 25% in the most recent year have a small icon appear to highlight that provider's experience to the user.

If you have other ideas for how we can help users find appropriate care, feel free to let us know.

Kaiser Health News reported on a brewing battle between physician assistants and doctors. Many physician assistants want to change their title to not include "assistant" anymore, instead preferring the title "physician associate." Some physician assistants argue that "assistant" is a misnomer because they frequently operate without direct oversight. Physician groups are concerned that members of the public might mistake "physician associate" as a "junior doctor."

Kaiser Health News reported on a brewing battle between physician assistants and doctors. Many physician assistants want to change their title to not include "assistant" anymore, instead preferring the title "physician associate." Some physician assistants argue that "assistant" is a misnomer because they frequently operate without direct oversight. Physician groups are concerned that members of the public might mistake "physician associate" as a "junior doctor."

Both groups seem to have good points. One advantage for physician assistants to be known as "physician associates" is that the abbreviation for their credential does not need to change. However, "associate" might blur the distinction between the two groups (physicians typically undergo a four-year medical school program in addition to a residency, whereas physician assistants tend train for two to three years) and many physicians are understandably keen to maintain a clear distinction between the groups in the public's understanding. It remains to be seen whether lawmakers and regulators will adopt the name change.

Happy Thanksgiving from DocSpot!

Happy Thanksgiving from DocSpot!

We're grateful for new partnerships this year and for new colleagues.

Kaiser Health News reported on some backlash against legislation passed last December against surprise medical bills. The legislation protected patients from unexpected bills, and left unresolved disputes between insurers and providers to be resolved by arbitration. It appears that Health and Human Services (HHS) recently released guidance on how arbitration would work, and many providers are unhappy. Apparently, the starting figure that might anchor the discussion is "the median rate the insurer pays in-network providers for similar services in the area." Although physicians can point out factors that might raise the arbitrated amount, the starting number seems to be what insurers would want in their ideal world: in-network prices. If out-of-network prices are essentially equivalent to in-network prices, insurers have much less incentive to offer higher prices to attract providers to join its networks. Not only that, insurers have an even stronger incentive to lower the amounts offered to its network, since that would affect both in-network and out-of-network prices.

Kaiser Health News reported on some backlash against legislation passed last December against surprise medical bills. The legislation protected patients from unexpected bills, and left unresolved disputes between insurers and providers to be resolved by arbitration. It appears that Health and Human Services (HHS) recently released guidance on how arbitration would work, and many providers are unhappy. Apparently, the starting figure that might anchor the discussion is "the median rate the insurer pays in-network providers for similar services in the area." Although physicians can point out factors that might raise the arbitrated amount, the starting number seems to be what insurers would want in their ideal world: in-network prices. If out-of-network prices are essentially equivalent to in-network prices, insurers have much less incentive to offer higher prices to attract providers to join its networks. Not only that, insurers have an even stronger incentive to lower the amounts offered to its network, since that would affect both in-network and out-of-network prices.

A couple of ideas that probably would have been more fair would be to either require insurers to sign up some large percentage of relevant providers in the area (e.g. 50%) or to use median prices across all insurer-provider combinations in the area. Both of these approaches would suffer some distortions if one side had too much market power in the area. For example, if a provider group had 60% of the relevant providers in that area, they could almost dictate whatever price they want. Inversely, if an insurer sold 80% of the relevant policies in that area, they could dictate fairly low prices. Getting health pricing policy right can be difficult.