Blog

Earlier this week, we released updated versions of our Terms of Service and Privacy Policy. The original versions were crafted in 2011, and our site features have changed since then.

Earlier this week, we released updated versions of our Terms of Service and Privacy Policy. The original versions were crafted in 2011, and our site features have changed since then.

In addition to matching our site's features, our intention was also to make the policies shorter and easier to read. If you have any questions about the new policies, please let us know.

The Centers for Medicare & Medicaid Services (CMS) proposed a number of updates to their regulations. Tucked away in the 1,883 pages was a proposal that hospitals publish their standard charges online in a machine readable format:

The Centers for Medicare & Medicaid Services (CMS) proposed a number of updates to their regulations. Tucked away in the 1,883 pages was a proposal that hospitals publish their standard charges online in a machine readable format:

"As one step to further improve the public accessibility of charge information, effective January 1, 2019, we are updating our guidelines to require hospitals to make available a list of their current standard charges via the Internet in a machine readable format and to update this information at least annually, or more often as appropriate. This could be in the form of the chargemaster itself or another form of the hospital's choice, as long as the information is in machine readable format."

If this proposal goes into effect, the change will mark significant progress towards pricing transparency. This policy will allow third-parties to aggregate pricing information to better help patients select hospitals which might better fit their budgets.

Over time, it would be nice for third parties to have information on procedure bundles -- for example, if someone were to go to a hospital for labor and delivery, what would the typical bill include? (e.g. facility fee, anesthesiology). That bundling would better help patients compare packages across various hospitals. It would also be nice for not only hospitals to post their prices, but medical groups as well, so that patients can better navigate selecting a clinic for outpatient procedures (including office visits).

A NPR reporter recounted her experience bringing her mother to an emergency room to treat the aftermath of a fall. Despite her familiarity with Medicare as a health policy reporter, the experience still presented new questions that she spent time unraveling for her audience. Generally, Medicare pays for rehabilitation care after someone is hospitalized, so why did it not cover the reporter's mother's rehabilitation care?

A NPR reporter recounted her experience bringing her mother to an emergency room to treat the aftermath of a fall. Despite her familiarity with Medicare as a health policy reporter, the experience still presented new questions that she spent time unraveling for her audience. Generally, Medicare pays for rehabilitation care after someone is hospitalized, so why did it not cover the reporter's mother's rehabilitation care?

It turns out that Medicare only pays for rehabilitation care after what's known as an inpatient visit of at least three days, and while the reporter's mother was in the hospital for over three days, she was considered to be under observation for enough of the time that she did not qualify for rehabilitation care. The reporter's investigations uncovered that hospitals are given incentives by Medicare to classify visits as observational rather than inpatient (inpatient visits are more expensive to Medicare).

Each piece of Medicare regulation might have made sense in isolation: if someone is only being observed, then Medicare shouldn't pay the more expensive rate for the more intensive treatment. It's unclear to me why Medicare might require an inpatient visit of a certain length before agreeing to pay for rehabilitation care. Presumably, the intention was something along these lines: if the visit were too short, then the patient likely had developed medical conditions over a period of time, and the conditions were largely unrelated to whatever brought the patient to the hospital, and the patient should pay for the rehabilitation of the long-term care, and not Medicare. Putting these regulations together, however, leads to some unexpected outcomes that can be very costly to patients.

Kaiser Health News reported on a vast pricing difference for two CT scans for the same patient in two different settings: in an imaging center and in an emergency room. The patient, on a high-deductible plan, owed $268 for the scan in the imaging center and $3,394 for the scan in the emergency room. The company owning the medical center that had the emergency room stated that care done in the emergency room context is more expensive because of the staffing and infrastructure requirements to provide emergency medical care for a wide variety of circumstances.

Kaiser Health News reported on a vast pricing difference for two CT scans for the same patient in two different settings: in an imaging center and in an emergency room. The patient, on a high-deductible plan, owed $268 for the scan in the imaging center and $3,394 for the scan in the emergency room. The company owning the medical center that had the emergency room stated that care done in the emergency room context is more expensive because of the staffing and infrastructure requirements to provide emergency medical care for a wide variety of circumstances.

To the extent that someone has to go to the emergency room (which wasn't strictly necessary in this case, although it was advised by a nurse practitioner), the patient really doesn't have much choice. For example, a patient might be incapacitated or suffering from a time-sensitive condition like a stroke. For other cases, however, enrollment in high-deductible health plans and awareness of these high prices may cause some patients to shift their behavior. Shift in patient behavior might end up supporting less traditional venues such as urgent care centers.

The New York Times outlined some interesting dynamics that are emerging in the world of primary care. For a long time, people went to their primary care physician for their first line of care. While their physicians might have had inconvenient hours (requiring patients to take time off of work), patients might have had few other choices. As urgent care centers and retail clinics have become more popular and have offered more convenient hours and locations, patients have started to engage with these new formats for their primary care. The traditional physician groups have taken notice and some have started to adapt by offering such formats themselves.

The New York Times outlined some interesting dynamics that are emerging in the world of primary care. For a long time, people went to their primary care physician for their first line of care. While their physicians might have had inconvenient hours (requiring patients to take time off of work), patients might have had few other choices. As urgent care centers and retail clinics have become more popular and have offered more convenient hours and locations, patients have started to engage with these new formats for their primary care. The traditional physician groups have taken notice and some have started to adapt by offering such formats themselves.

Where consumers have a choice and where suppliers have an incentive to better meet consumer needs, healthy market dynamics will often drive the suppliers to offer better value (in this case, more convenient venues). There appears to be some question as to whether or not the quality of care is the same across these different formats. If quality metrics (and results) were readily available, consumers might be able to make an even more informed choice.