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Happy Thanksgiving from the team at DocSpot!

Happy Thanksgiving from the team at DocSpot!

Kaiser Health News put together a "consumer's guide" to the new reimbursement system that Medicare is rolling out. A key change is that Medicare is trying to shift its payment away from fee-for-service (where doctors get paid more to do more, regardless of whether the additional activity is needed or cost-effective) and towards value-based care. An example of the underlying philosophy is that it's both cheaper and better to treat and coach a patient so that s/he won't need a surgery than it is to have the surgery. An administrative side effect of the way that Medicare is rolling out the new program is that doctors will be encouraged to join larger organizations through increasing penalties (for abstaining) and bonuses (for joining). Quality and efficiency of a practice are easier to evaluate when the practice is larger and the statistics are less likely to be thrown off by a few outliers.

Kaiser Health News put together a "consumer's guide" to the new reimbursement system that Medicare is rolling out. A key change is that Medicare is trying to shift its payment away from fee-for-service (where doctors get paid more to do more, regardless of whether the additional activity is needed or cost-effective) and towards value-based care. An example of the underlying philosophy is that it's both cheaper and better to treat and coach a patient so that s/he won't need a surgery than it is to have the surgery. An administrative side effect of the way that Medicare is rolling out the new program is that doctors will be encouraged to join larger organizations through increasing penalties (for abstaining) and bonuses (for joining). Quality and efficiency of a practice are easier to evaluate when the practice is larger and the statistics are less likely to be thrown off by a few outliers.

Kaiser Health News reported that Medicare will be posting some information about how doctors are rated on its Physician Compare website. If the rating system is generally accepted by the medical community, it could be very helpful in educating consumers on how to select a provider.

Republicans have long been trying to repeal or undermine the Affordable Care Act. With the Republicans gaining control of the White House and both houses of Congress, many are wondering what will happen to the legislation. The Democrats hold enough seats in the Senate that they should be able to filibuster attempts to simply repeal the ACA. However, even if the Republicans could pass whatever legislation they wanted to replace ACA, The Washington Post points out that the Republicans will be hard-pressed to come up with a plan that meets their objectives and would be liked by Americans, without seeming too similar to ACA itself. Certain Republican ideas -- such as allowing individuals who purchase their own insurance to receive a tax deduction like employers currently do and expanding access to Health Savings Accounts -- seem like good ideas, but unlikely to be sufficient on their own. The article lists a number of areas that Republicans might want to trim, but also points out how their current popularity would make them difficult targets.

Republicans have long been trying to repeal or undermine the Affordable Care Act. With the Republicans gaining control of the White House and both houses of Congress, many are wondering what will happen to the legislation. The Democrats hold enough seats in the Senate that they should be able to filibuster attempts to simply repeal the ACA. However, even if the Republicans could pass whatever legislation they wanted to replace ACA, The Washington Post points out that the Republicans will be hard-pressed to come up with a plan that meets their objectives and would be liked by Americans, without seeming too similar to ACA itself. Certain Republican ideas -- such as allowing individuals who purchase their own insurance to receive a tax deduction like employers currently do and expanding access to Health Savings Accounts -- seem like good ideas, but unlikely to be sufficient on their own. The article lists a number of areas that Republicans might want to trim, but also points out how their current popularity would make them difficult targets.

Probably to the relief of many who have had trouble getting insurance before, The Wall Street Journal published an article indicating that the president-elect would like to keep the prohibition on insurers from denying coverage for pre-existing conditions. Avik Roy, a conservative health policy commentator, has been quick to point out that this position is consistent with what was said on the campaign trail.

The third-party payer problem is an issue that has plagued healthcare for a long time. When faced with what might seem like a potentially life-altering situation and the option of low-cost and relatively unknown medical provider versus the option of a well-known but very expensive provider, patients have very little incentive to care about cost if the personal cost after insurance is the same (e.g. co-pay). Even if the final amount is different (e.g. through co-insurance), the difference might be small enough to be worthwhile to the patient and still result in a large difference to the payer. This situation has been slowly changing over the last decade, as more and more Americans have been enrolling in high-deductible plans. The Wall Street Journal published an article about some employers turning to tools to help their employees shop for care, and adding incentives for their employees to care. This move makes sense; after all, why should an individual patient restrict his or her choices only so that the employer benefits from the savings? (In theory and in aggregate, lower medical costs could mean higher wages for employees, but any individual decision is far enough removed from the employee's direct compensation that employees generally would understandably not give much consideration to the difference.)

The third-party payer problem is an issue that has plagued healthcare for a long time. When faced with what might seem like a potentially life-altering situation and the option of low-cost and relatively unknown medical provider versus the option of a well-known but very expensive provider, patients have very little incentive to care about cost if the personal cost after insurance is the same (e.g. co-pay). Even if the final amount is different (e.g. through co-insurance), the difference might be small enough to be worthwhile to the patient and still result in a large difference to the payer. This situation has been slowly changing over the last decade, as more and more Americans have been enrolling in high-deductible plans. The Wall Street Journal published an article about some employers turning to tools to help their employees shop for care, and adding incentives for their employees to care. This move makes sense; after all, why should an individual patient restrict his or her choices only so that the employer benefits from the savings? (In theory and in aggregate, lower medical costs could mean higher wages for employees, but any individual decision is far enough removed from the employee's direct compensation that employees generally would understandably not give much consideration to the difference.)

The numbers discussed in the article seem small. Over the next several years, I suspect that an increasing number of large employers will be turning to programs similar to what was outlined to help reduce growth in medical spending.

CMS published results of a survey to verify the accuracy of listings in the online doctor directories of some Medicare Advantage plans. Apparently, verifying information by calling doctors' offices revealed incorrect information for almost half the cases, an error rate so high that regulators are said to have been surprised. The sample seems small -- only 108 doctors -- but I am personally not surprised by the error rate.

CMS published results of a survey to verify the accuracy of listings in the online doctor directories of some Medicare Advantage plans. Apparently, verifying information by calling doctors' offices revealed incorrect information for almost half the cases, an error rate so high that regulators are said to have been surprised. The sample seems small -- only 108 doctors -- but I am personally not surprised by the error rate.

Thinking about the logistics from the doctor's perspective, it is perhaps understandable how online doctor directories can become so out-of-date. Whenever a doctor's office moves or updates a phone number, someone generally needs to update information at multiple places (at least once per insurer). Each insurer probably has a different process, and if any process requires multiple steps, it's easy to see how information gets lost on its way to the insurers. The federal government could play a role in simplifying the process for doctors. They could offer one centralized portal where doctors can update their information (for multiple practice locations, if applicable), and indicate which insurance plan they accept at each of their locations. Such directories could be made available in machine-readable form to everyone, including insurance companies who could then import such data to populate their own directories. This would save doctors time, save insurers the hassle of prompting doctors to verify information, and benefit patients with more accurate information. Already doctors who accept insurance in the US must register for a National Provider Identifier, which could easily form the basis of this portal. Unfortunately, insurance companies would likely object to their provider networks becoming public. At this point, however, provider networks sufficiently affect the quality of the plans that they should be public so patients can more easily compare their options.