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The holiday season is already upon us! Happy Thanksgiving!

We have a lot to be thankful for this year, and hope that you do as well.

As another example of a conflict of interest in health care, Kaiser Health News published accusations that a large hospital chain created incentives to encourage doctors to admit more patients. Hospitalizations are expensive for patients (or at least their payers), but can be helpful to hospitals' bottom lines. Who decides whether a patient in an emergency room gets admitted? Doctors who might be employed by the hospital (or might have some other formal relationship). To be clear, critics of the hospital chain were the ones making the accusations; Kaiser Health News was only reporting on those accusations. As is typical for many Kaiser Health News articles, this article starts with a personal encounter of someone with the healthcare system and in this case, reports that patient regrets agreeing to be hospitalized. Although the patient had insurance, she was still expected to pay several thousand dollars.

A single story is not enough to substantiate accusations of a widespread policy. However, the article references a whistleblower who indicated that the hospital chain threatened his employment if he did not admit more patients. Attorneys representing the whistleblower also found higher rates of admission among Medicare patients at the hospitals in this chain versus other hospitals. Surprisingly, the federal government declined to pursue the case.

This week, we have released changes that might be helpful for anyone who seeking mental health providers. Searching for "mental health" should now bring up advertisements that lead to a discount at one of our partners that is a network of mental health providers.

Mental health seems to be a growing concern, and we hope that this offer will be helpful to some. Our future plans include highlighting some mental health providers and topics.

One of the problems of how health care is paid for in the US is what is known as the third-party payer problem: the entity that pays (generally, an insurer) is different from the one making a decision (the patient). As a result, patients are largely shielded from the financial consequences of their healthcare decisions and will frequently select a provider based on other factors. The theory is that if patients were more price-sensitive, more healthcare providers would reign in their prices (perhaps by being more efficient). Kaiser Health News published an article about Colorado's state government (part of a purchasing alliance, along with some other employers) offering patients cash incentives for selecting a provider that was ranked within the 25% for both quality and cost.

The article cited a study that found that various "orthopedic surgeries were an average of 26% lower at ambulatory surgery centers than at hospitals." With that in mind, it is easy to see how the payer can end up saving money, despite giving patients cash incentives. There are still questions of how well incentive programs like this one will fare in the long term, and a key question will be whether patients believe in the quality rankings (or at least that the relevant choices offer adequate quality of care). The end of the article mentions a few reasons that early versions of this program might not survive the long term. Regardless, it seems positive that payers are experimenting with different incentive models to try to steer patients towards better value.

Have you ever had the experience of a company overcharging you, but not listening to your reasons for their incorrect charging? Kaiser Health News published a story about one doctor being overcharged and his wife's subsequent experience in getting the charge corrected.

Although the outcome was positive (with the couple saving over $2,000), it's notable that the patient himself is a doctor and that his wife oversees billing at the patient's practice. Even still, the couple had challenges getting their charges rectified. Perhaps not surprisingly, the hospital stated that its charge for a specific procedure was reasonable, despite being nearly double the out-of-network price estimated for that hospital's ZIP code. What is surprising, though, is the insurer's unwillingness to engage with the dispute -- despite the possibility of saving thousands of dollars. The final resolution was that the hospital admitted to charging for a procedure that was not actually performed. Unfortunately, the discrepancy is not one that was easily determined by the patient or his wife, let alone the average patient. The entire account raises the larger question of how frequently this type of mistake happens, and whether the system could be set up differently to better protect against these mistakes.