Blog

Kaiser Health News reported on an ongoing clash in the state of Ohio, which passed a law to make "good-faith" estimates of medical procedures available to patients before they select a provider. This seemingly straightforward law has met resistance from the medical community, including from Ohio Hospital Association, which claims that compliance would delay patient care.

Kaiser Health News reported on an ongoing clash in the state of Ohio, which passed a law to make "good-faith" estimates of medical procedures available to patients before they select a provider. This seemingly straightforward law has met resistance from the medical community, including from Ohio Hospital Association, which claims that compliance would delay patient care.

Assuming that the estimates do not have to include patient-specific information (such as deductible already spent), the claim of delayed patient care seems ridiculous -- providers (especially hospitals) have electronic billing systems that could be used (or perhaps adapted) to quickly generate reasonable estimates. Even if generating estimates were unwieldy, why should patients be expected to select a provider without such information? What other industry would push back against having to supply reasonable estimates? Hopefully, common sense will prevail and the courts will uphold patient rights to pricing transparency before selecting a provider.

The Republican effort to repeal and replace the Affordable Care Act encountered yet another obstacle. The effort was already widely unpopular, with Democrats firmly opposing it. Two Senate Republicans also publicly declared their opposition to the Republican proposal, leaving a tenuous path to passing the bill by relying on a tie-breaking vote. Adding to all of that, Kaiser Health News reports that the Senate Parliamentarian has advised that several clauses require more than a simple majority to become law. Current Senate rules are that a super-majority of 60 votes are required for legislation to not be filibustered.

The Republican effort to repeal and replace the Affordable Care Act encountered yet another obstacle. The effort was already widely unpopular, with Democrats firmly opposing it. Two Senate Republicans also publicly declared their opposition to the Republican proposal, leaving a tenuous path to passing the bill by relying on a tie-breaking vote. Adding to all of that, Kaiser Health News reports that the Senate Parliamentarian has advised that several clauses require more than a simple majority to become law. Current Senate rules are that a super-majority of 60 votes are required for legislation to not be filibustered.

This assessment from the Parliamentarian seems like a significant setback to the Republican efforts. With many state health insurance exchanges experiencing aggressive premium increases, perhaps both sides will be motivated to work together towards a new policy. The notion of new and meaningful legislation having bi-partisan support seems quaint given the political climate over the last decade, but perhaps the process yields better and longer-lasting policies.

Along with a few other states, California publicly reports the performance of individual cardiac surgeons. Los Angeles Times reported on the contrasting reactions of two surgeons rated as worse than average. The first surgeon raised a long standing argument of critics of these transparency efforts: that surgeons will be discouraged from taking on patients who have more complicated conditions. The other surgeon welcomed the public reporting, but noted the short duration covered.

Along with a few other states, California publicly reports the performance of individual cardiac surgeons. Los Angeles Times reported on the contrasting reactions of two surgeons rated as worse than average. The first surgeon raised a long standing argument of critics of these transparency efforts: that surgeons will be discouraged from taking on patients who have more complicated conditions. The other surgeon welcomed the public reporting, but noted the short duration covered.

Both surgeons raise legitimate concerns. The antidote for the second one is easier to address: publish more data. The first concern is more complicated. The publishers of the data already risk-adjust the outcomes, meaning that, in theory, providers who take on patients with complicated conditions are not penalized for doing so. Of course, risk-adjustment is far from settled science, and there are a variety of ways of doing so. What could help is to publish the underlying data, along with the risk-adjustment algorithms and invite comment from the academics who study it. While that won't fully address the issue in the short-term, it advances the discussion around quality metrics in hopes of at some point coming up with some usable measures. At least, that's much better than just suppressing the data.

In the current milieu of Republicans trying to replace the Affordable Care Act with a variety of options that will lead to more uninsured, The Washington Post reports that Democrats are increasingly supportive of a single-payer option. We recently saw news of the California Senate approving of single-payer health care, but this article reports that the current White House spokesperson claimed that a majority of House Democrats support single-payer health care. If true, this represents a significant shift from attitudes when the Affordable Care Act passed.

In the current milieu of Republicans trying to replace the Affordable Care Act with a variety of options that will lead to more uninsured, The Washington Post reports that Democrats are increasingly supportive of a single-payer option. We recently saw news of the California Senate approving of single-payer health care, but this article reports that the current White House spokesperson claimed that a majority of House Democrats support single-payer health care. If true, this represents a significant shift from attitudes when the Affordable Care Act passed.

The political landscape seems rather confusing given the two parties trying to pull in opposite directions, and with increasingly pessimistic news about the status quo.

Last year, there was some press around the practice known as balance billing, where patients who are treated by out-of-network providers may be billed for services if the patients' insurers refuse to pay. In theory, patients who choose to visit out-of-network providers should pay according to their insurance policies; however, in practice, patients are often stuck with bills even when they are careful to select in-network facilities. Kaiser Health News reported on such a story and on how new regulations are coming into effect to combat such practices. While the regulation does not seem to address exactly how the bill will resolve between the providers and the insurers, it protects the patients from balance billing if they visit an in-network facility.

Last year, there was some press around the practice known as balance billing, where patients who are treated by out-of-network providers may be billed for services if the patients' insurers refuse to pay. In theory, patients who choose to visit out-of-network providers should pay according to their insurance policies; however, in practice, patients are often stuck with bills even when they are careful to select in-network facilities. Kaiser Health News reported on such a story and on how new regulations are coming into effect to combat such practices. While the regulation does not seem to address exactly how the bill will resolve between the providers and the insurers, it protects the patients from balance billing if they visit an in-network facility.

The regulation does allow patients to still choose to be treated by an out-of-network provider, but requires their signed consent at least 24 hours in advance. This seems like a sensible policy in that it still preserves patient choice while protecting them from surprise bills.