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Related to an earlier post, some doctors have joined together to voice opposition to California's solution to surprise billing. The video features many different physicians going through various talking points (it would seem more honest for them to just say that they want to be paid more instead of trotting out the line "patients over profits"). Fortunately, the physicians do not object to ending surprise billing altogether, but rather a specific component of California's legislation called benchmarking -- the practice of resolving disputes between providers and payers by referencing the local average (a practice that I thought gave too much power to insurers). The video does underscore its support for New York's version of the legislation.

Related to an earlier post, some doctors have joined together to voice opposition to California's solution to surprise billing. The video features many different physicians going through various talking points (it would seem more honest for them to just say that they want to be paid more instead of trotting out the line "patients over profits"). Fortunately, the physicians do not object to ending surprise billing altogether, but rather a specific component of California's legislation called benchmarking -- the practice of resolving disputes between providers and payers by referencing the local average (a practice that I thought gave too much power to insurers). The video does underscore its support for New York's version of the legislation.

I found a Vox article that explains how disputes between providers and payers are resolved under the New York law. Instead of referencing local averages, the New York legislation apparently takes its cues from Major League Baseball. Under this model of arbitration, a neutral third-party is appointed, and both the provider and the payer are allowed to each give one number, and the arbiter can only choose one of those two numbers. By not allowing the arbiter to make up a third number, each party has an incentive to temper its own number in hopes that it will be selected. This arbitration model does indeed seem more fair, assuming that both sides believe the arbiters are neutral.

Unfortunately, it seems that New York's law does not protect patients who rely on mistaken information given by the provider's office. For example, if a provider claims to be in-network, but is not actually, apparently, the patient can be on the hook for the out-of-network price. It feels that there should already exist other types of consumer protection laws covering that case.

Kaiser Health News reported that Walmart is continuing its exploration of nudging its employees towards certain healthcare providers. Earlier, Walmart had given employees financial incentives to select certain hospitals over others. Now, Walmart is trying out a pilot program to do so with individual doctors. The pitched idea is that patients that go to higher quality providers can avoid unnecessary care, reducing costs in the long run.

Kaiser Health News reported that Walmart is continuing its exploration of nudging its employees towards certain healthcare providers. Earlier, Walmart had given employees financial incentives to select certain hospitals over others. Now, Walmart is trying out a pilot program to do so with individual doctors. The pitched idea is that patients that go to higher quality providers can avoid unnecessary care, reducing costs in the long run.

The article mentions risks of alienating providers (many of whom do not like to be graded) and potentially upsetting employees who do not want to change physicians. In isolation, the risks do not seem significant at this point. However, when insurers earlier tried programs known as Pay For Performance where physicians who met certain guidelines were awarded bonuses, the medical community frequently objected and the popularity of those programs faded away. It remains to be seen whether the medical community will accept these criteria, whether many employees will comply, and whether the shift in employee choices will result in cost savings.

The New York Times reported that the issue of surprise billing has been getting more attention at the national level. Apparently, California's legislation has garnered much attention. Interestingly, Brookings reported that after California's legislation went into effect, insurance companies' network of physicians increased by about 16%. The theory is that by reducing the attractiveness of remaining out-of-network, more physicians will agree to be in-network. California's legislation achieves this effect by stipulating that insurance plans need only to "pay out-of-network physicians at in-network hospitals the greater of the insurer's local average contracted rate or 125% of the Medicare reimbursement rate."

The New York Times reported that the issue of surprise billing has been getting more attention at the national level. Apparently, California's legislation has garnered much attention. Interestingly, Brookings reported that after California's legislation went into effect, insurance companies' network of physicians increased by about 16%. The theory is that by reducing the attractiveness of remaining out-of-network, more physicians will agree to be in-network. California's legislation achieves this effect by stipulating that insurance plans need only to "pay out-of-network physicians at in-network hospitals the greater of the insurer's local average contracted rate or 125% of the Medicare reimbursement rate."

California's legislation might introduce some interesting quirks. For example, insurance companies now have a much stronger incentive to not contract with the most expensive providers, since removing them from the network would reduce the average for all out-of-network providers. Additionally, instead of paying above-average rates, payers can now just pay average rates when their patients go to that provider (if the payer refused to contract with those most expensive providers). This immediate effect might be the legislation's intention, but the effect might lead to a downward pressure on quality. Suppose, for example, higher quality medicine is more expensive to deliver (a supposition not yet academically proved): in that case, insurers may be tempted to not contract with the expensive providers for a short-term boost of cheaper, higher-quality care. In the long-run, however, such providers might go out of business or might cut back on their quality. A way to balance this would have been to pick a reimbursement percentile higher than 50% (e.g. 65%) of the local average such that insurers have a stronger incentive to negotiate for providers to contract with them. Alternatively, payers might have been able to largely solve this problem by offering higher rates to (or contracting exclusively with) providers who agree to never consult with out-of-network providers (or at least pay for any charge differences) for the insurers' patients (this does not solve the case of when a patient has an emergency and goes to the nearest provider, who is out-of-network). Another reasonable option might have been to limit physician reimbursement to something like 400% of Medicare's reimbursement rate -- in which case insurers would have a strong incentive to negotiate, but have limited prices in the cases of emergencies.

In another sign of changing times, Kaiser Health News published an interesting article about health care being sold on Groupon, a website traditionally oriented around consumer retail experiences (e.g. restaurants). Groupon is known for its heavy discounting, and Groupon keeps a large cut of what it helps sell (around half). Thus, that healthcare institutions have started to make their services available through Groupon suggests that an increasing number of provider organizations are looking for new channels of bringing in revenue.

In another sign of changing times, Kaiser Health News published an interesting article about health care being sold on Groupon, a website traditionally oriented around consumer retail experiences (e.g. restaurants). Groupon is known for its heavy discounting, and Groupon keeps a large cut of what it helps sell (around half). Thus, that healthcare institutions have started to make their services available through Groupon suggests that an increasing number of provider organizations are looking for new channels of bringing in revenue.

Interestingly, one provider organization indicated that it started offering its services on Groupon in response to other organizations already doing so. That response suggests that competition is at work. It will likely still be a long time before we see more sophisticated procedures being sold like this (if ever), but that there are some services available through this non-traditional channel suggests that some patients are keen on more affordable health care, and some providers would very much like to provide that.

We recently released some updates to our provider interface. For several years, providers have been able to claim their profiles and update or add information. However, each update required visiting a separate page and then returning to the original profile. Instead, we have made the updates inline so that the update process is more streamlined.

We recently released some updates to our provider interface. For several years, providers have been able to claim their profiles and update or add information. However, each update required visiting a separate page and then returning to the original profile. Instead, we have made the updates inline so that the update process is more streamlined.

We have other user interface improvements planned or in the pipeline. If you have any feedback, please let us know.