Another skirmish for transparency
February 21, 2016
At DocSpot, our mission is to connect people with the right health care by helping them navigate publicly available information. We believe the first step of that mission is to help connect people with an appropriate medical provider, and we look forward to helping people navigate other aspects of their care as the opportunities arise. We are just at the start of that mission, so we hope you will come back often to see how things are developing.
An underlying philosophy of our work is that right care means different things to different people. We also recognize that doctors are multidimensional people. So, instead of trying to determine which doctors are "better" than others, we offer a variety of filter options that individuals can apply to more quickly discover providers that fit their needs.
February 21, 2016
The Washington Post published a blog post commenting on a defamation suit brought against CNN by Dr. Michael Black, a surgeon who worked at St. Mary's Medical Center in West Palm Beach, FL. The blog post highlights a number of interesting angles about this conflict. For one, the lawsuit touches on why statistics such as mortality rates can be difficult to determine: even figuring out what should be included in the denominator can be tricky. The numerator itself is not straightforward, since the number of adverse events may be risk-adjusted for the complexity of the cases.
What's particularly interesting to me is that both the hospital and the surgeon have pointed out inaccuracies in CNN's methodology, but apparently have not furnished data themselves. If a surgeon truly thought that his record was stellar, I'd imagine that he would actually be eager to share his data. Instead, the hospital and doctor seemed to have only criticized CNN's efforts without indicating what the actual numbers should be. I suspect that over time, the position maintained by the hospital and doctor will not be viewed favorably by patients.
February 13, 2016
The world of health insurance is complex. Insurers can make more money when they attract a wide pool of subscribers, but can avoid paying expensive claims. Before the Affordable Care Act, insurers would commonly deny coverage to those who had medical conditions that might be expensive to treat (known as "pre-existing conditions"). With the passage of Affordable Care Act, insurers can no longer deny coverage to individuals. As might be expected, insurers have looked for other ways to maximize profitability. One method that makes sense is the use of narrow networks: in exchange for more affordable health care, subscribers agree to give up access to more costly providers (or at least pay for the care themselves when they visit). However, when nearly everyone selects such plans for their costs, then the more expensive plans that offer broader access are full of subscribers who benefit from the higher-cost providers, even after paying for higher premiums. The cost of those plans then skyrocket. As a result, we've seen many insurance companies stop offering PPO plans, which offer greater selection. To some, this has the effect of denying expensive coverage, somewhat akin to the older form of denying coverage to people with pre-existing conditions.
Health insurance companies are companies, and therefore shouldn't be reprimanded for trying to maximize profits as other companies do (such as pharmaceutical companies and for-profit hospitals). It obviously makes sense to have some regulation to help ensure that insurers are paying what they promise. At the same time, it's very easy to get that regulation wrong -- sufficiently motivated organizations can find the vulnerabilities of bad policy and exploit them for financial advantage.
February 06, 2016
Kaiser Health News published an interesting article recounting some of the travails that insurance companies have been encountering on insurance exchanges. Apparently, even though gold plans cost consumers more, they have proven unprofitable for a number of health insurance companies. The plans have proven so unprofitable that the pool to help mitigate against high-cost patients has been more than depleted, with HHS only having enough to pay 13% of what it owed for 2014. It's unclear to me why the insurance companies can't simply raise premiums to make those plans more profitable. Instead, some health insurance companies are trying to reduce enrollment in the unprofitable plans by not paying commission to brokers when they sign someone up for a gold plan.
Apparently, a number of people signed up for insurance plans outside of the regular enrollment window and some of them have been exiting their insurance plans after expensive treatments. To discourage this practice, some insurance plans are also eliminating commissions for brokers when they sign someone up outside of the regular enrollment window.
January 31, 2016
The Kaiser Family Foundation published a survey with interesting results. Apparently, people's views of the Affordable Care Act haven't changed that much since 2010 (slightly more negative). Surprisingly, despite all the complaints about the cost of health care, 61% of non-elderly insured Americans think that their health insurance is a good value or an excellent value. Also somewhat surprising (in light of news about narrow networks) is that 84% of non-elderly insured Americans are somewhat satisfied or very satisfied with their selection of doctors. Overall, the price of various aspects of health care seem to be important to be people, but not an overriding concern.
The poll only sampled 1,204, so it's unclear to me how representative the findings are.
January 23, 2016
For a while now, Medicare has been transitioning away from strictly flat-fee payments (fee-for-service). For example, a while back, Medicare introduced the concept of bundled payments for hospital procedures, where hospitals are reimbursed one total amount for an inpatient visit, regardless of the hospital's cost. It has since moved on to rewarding those hospitals that perform well on certain quality metrics and imposing penalties on hospitals with high readmission rates. On the individual physician level, Medicare started to pay doctors extra if they used a certified electronic health record with the HITECH Act. Medicare also started paying for doctors to report certain outcome information via a program known as PQRS.
While the payouts of the physician programs have been a relatively small portion of the overall Medicare payments, last year, Medicare announced that they aspire to link 30% of their payments to getting better results and better value. That percentage is to rise to 50% in 2018. That they recently reiterated those goals suggest that maybe we will see a significant shift in payments, and therefore practices. It'll be interesting to see how much that percentage actually changes throughout 2016.