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We wish you a happy new year!

We wish you a happy new year!

Wishing you all a Merry Christmas!

Wishing you all a Merry Christmas!

The New York Times reported on a study that examined variation in outcomes of medical care provided in places across the country. The study reviewed 22 million inpatient admissions and concluded that outcomes can vary greatly, depending on where the care is received, and suggested that not all hospital networks are of the same quality. If different hospitals perform differently, regulators may need to consider whether limited provider networks (used to reduce cost) are truly adequate.

The New York Times reported on a study that examined variation in outcomes of medical care provided in places across the country. The study reviewed 22 million inpatient admissions and concluded that outcomes can vary greatly, depending on where the care is received, and suggested that not all hospital networks are of the same quality. If different hospitals perform differently, regulators may need to consider whether limited provider networks (used to reduce cost) are truly adequate.

For heart attacks, it appears that more than twice the number of patients died in the worst performing hospitals than the best performing hospitals (on a risk-adjusted basis). This could be a very meaningful difference for patients. Unfortunately, the data underlying the study is not available for public use, meaning that patients cannot benefit by knowing which hospitals in their area perform better than others. Transparency would be helpful.

Kaiser Health News ran an article about medical centers, hospitals, and doctors' offices increasingly asking patients to pay their portion of the appointment or procedure fees upfront. Some medical facilities have been doing this for several years, but as deductibles continue to rise, it appears that this practice is becoming more commonplace.

Kaiser Health News ran an article about medical centers, hospitals, and doctors' offices increasingly asking patients to pay their portion of the appointment or procedure fees upfront. Some medical facilities have been doing this for several years, but as deductibles continue to rise, it appears that this practice is becoming more commonplace. While this practice may seem jarring to the patient (to have to worry about the financial consequences before the appointment or procedure), medical groups hope to reduce the time they spend collecting on bills and the amount of bad debt they experience.

The article profiled an administrative assistant who needed a hysterectomy and was asked to pay upfront. She had insurance, but the deductible was $5,000, and the doctor estimated that the patient portion would be around $2,500. The administrative assistant said that she was angry at being asked to pay for her portion of medical care before she could receive service. Previously, it was much more common for the procedure to be done, then the insurance billed, and then finally the patient billed for the patient portion. However, a number of patients would then be unable or unwilling to pay, forcing medical groups to write off uncollected amounts as bad debt. All of this raises the question: what should happen when someone is unable to pay for necessary medical care? Under the older model, medical groups would simply expect to not see some of their billings (which they claim forces them to raise prices on everyone to cover what is known as "charity care"). Notably, some non-profit hospitals have received bad press for their aggressive collection tactics. Should the insurance company pay? The premium was priced assuming a certain deductible; forcing insurers to pay would certain raise premiums for the general population. Should the government pay? Should the patient be forced to wait? These are questions that significantly affect health policy, and ones that do not lend themselves to easy answers. While America figures out a response to these questions, the medical community has understandably taken steps to protect its bottom line. Should this practice become more commonplace, it might have the effect of forcing patients to be more discriminating in the care they receive and their selection of a medical practice to visit. Ultimately, forcing patients to shop around might actually create more pricing pressure on the providers.

Concurring with a number of other articles this year published elsewhere, Kaiser Health News published an article about inaccuracies in insurance companies' provider directories. This article focused on whether doctors are accepting new patients who have particular insurance plans, reporting that one patient called over 300 physicians when shopping for health insurance.

Concurring with a number of other articles this year published elsewhere, Kaiser Health News published an article about inaccuracies in insurance companies' provider directories. This article focused on whether doctors are accepting new patients who have particular insurance plans, reporting that one patient called over 300 physicians when shopping for health insurance. Inaccuracies in terms of whether a doctor is accepting new patients with a particular insurance plan make it difficult to assess whether a plan is better or worse than another plan. While a plan can claim to have a broad network of providers to choose from, such supposed breadth is not meaningful if patients cannot actually visit the providers. Accuracy is especially important when the government assesses whether or not a plan has adequate network coverage.

Keeping these directories up-to-date is certainly tedious. However, rather than have millions of individual consumers call around and check (with doctors' offices fielding multiple such calls from different consumers), it makes sense to centralize the costs at either the insurance company level or potentially, with some government agency. Unfortunately, the article indicates that federal regulation in this area has not been enforced.