For my colonoscopy, I chose quality over cost

December 21, 2013 in health care costs, Quality of care

I finally got that colonoscopy that I started shopping for almost a year ago. I’m really good at proscrastinating when fasting and voluntary diarrhea is involved.

I had a good experience in the end. I probably spent more than I should have, but…

1) I wanted to go someplace close to home. You’re not supposed to drive after this procedure and I didn’t want to drag a designated driver too far out of the way.

2) So I compared a doctor recommended by my PCP, who is at Beth Israel Deaconess Medical Center with a team of docs at Faulkner Hospital. Yes, the Faulkner is owned by Partners, but rates I’ve seen for the Faulkner are more in the community hospital range. I’m pretty sure BIDMC would be more expensive, but I don’t have the exact charges

The problem was, I couldn’t get any quality info from the Faulkner. I called four times and spoke to someone twice. They said they couldn’t answer my questions about: polyp detection rates, complication rates, withdrawl time and how often the doctor reaches the beginning of the colon (the cecum).

So I went to BIDMC, which had offered quality info earlier this year and where I had a frank conversation with my doctor (although not until just before the procedure).

I came away with an interesting, gross to some of you, set of slides of my doc’s work. Dr. Chuttani always, apparently, gets to the cecum and takes a picture. You can click to the next page to see mine (I don’t want to force it on you). Did you doctor show you results of the procedure?
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What would happen if my doctor wore the johnny and I had on a fancy robe?

December 18, 2013 in Member Stories

 

Screen Shot 2013-12-18 at 11.23.18 PM
There’s something about changing into a johnny, the clothing equivalent of a paper bag, that strips our confidence, intelligence and power as patients.  So what would the office visit feel like if the patient put on a luxurious dressing gown and the doctor wore a johnny?  The wardrobe power swap wouldn’t, alone, re-balance the doctor-patient relationship, but would it help?

Thanks for the ‘toon Tyler!

Massachusetts man dies after losing coverage for two months

December 17, 2013 in Health Insurance, Member Stories

The man I’ll call George died at a hospital in Massachusetts last April.  He had AIDS and Hepatitis C. George was managing both until February when his state subsidized insurance coverage ended.  He’d started earning too much money and no longer qualified.  George, a construction contractor, found an employer who let George sign on to the company plan.  He submitted the paperwork, but there was a delay. This happens. There might be some missing information or the first month’s payment is late.  For George, there was a 10 week gap between when his coverage through Commonwealth Care ended and his new insurance plan kicked in.

In February, while he was uninsured, George stopped taking his medicine.  He didn’t have the roughly $4400 a month to refill his AIDS prescriptions.  George skipped his meds again in March.  That month George got a bad cough.

He went to the hospital.  George had had pneumonia before and was pretty sure he had it again.  A doctor gave him a prescription and sent him home.  By the time George returned to the hospital, a virulent strain of pneumonia had settled into both lungs.  George, with his weakened immune system, couldn’t beat it.  Two months after George lost his coverage and stopped filling his prescriptions, he died. A letter telling George his new insurance was active arrived a few weeks later.

I heard this story from a doctor who treated George and his long term partner.  I don’t have all the details and am not using George’s real name because his family is embarrassed about the fact that he had AIDS.

I’m sharing what I do know of the story because the tragedy of George’s death is especially potent right now.  The state Health Connector website is still having problems.  Connector staff and board members have extended the current coverage for members in an effort to make sure that no one goes without health insurance while the re-enrollment problems continue.  But there are concerns that people will get frustrated and either give up or will put off going through the process of choosing a new plan.  Many of us push letters from our insurance companies aside, thinking they aren’t that important or won’t make sense if we do open them.

A lapse in coverage might not matter for most of us. We aren’t in the same precarious state as was George last February.  But don’t delay. Going without coverage for even a couple of months can be deadly.

 

 

 

Consumer Affairs Issues Report, Holds Second Conference on Transparency

October 18, 2013 in Member Stories

According to a report on healthcare transparency issued by the Office of Consumer Affairs and Business regulation, Massachusetts consumers are more likely to research the cost of a TV than to research the cost of their medical care, however, most consumers would like to be able to compare costs of medical services from different providers.

The report details findings from a daylong conference with health care leaders in May.

Conference attendees were also polled on their attitudes about health care, answering questions at both the beginning and end of the conference about how important it is to know costs ahead of time for healthcare services and whether a comparison of prices would affect choices about where to receive care.

The final findings of the break out groups, which are detailed on page ten of the report, shed some light on how price and quality information affect healthcare consumers’ decision-making:

  • Cost is a factor, but not the most important one;
  • Doctors are important and  influential in the decisions about healthcare;
  • Consumers want more  information about price, quality and options; and
  • Consumers should  understand more about the variables that affect their own health care.

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Breast Cancer Awareness Month: Instilling Confidence in Women through Shared Decision Making

October 11, 2013 in Member Stories

According to the American Cancer Society, an estimated 232,340 new cases of invasive breast cancer will be diagnosed in women in 2013, making it the second leading cause of cancer death in females, exceeded only by lung cancer.  For the 28th consecutive year, the sea of pink can be seen almost everywhere as individuals, charitable organizations and commercial organizations across the country once again joining forces in support of National Breast Cancer Awareness Month and the many women affected by breast cancer.

Being diagnosed with breast cancer can be a scary and overwhelming experience for women and their families.  That’s why it’s important that they have access to resources that will fully inform them about their medical condition, allowing them to make an educated decision about what treatment option is best for them, personally.  And because there are several treatment options – each with differentl risks and benefits – it’s even more important that a patient’s personal preference drive a treatment decision.   This concept of empowering patients and their families to make informed decisions about their condition and treatment—decisions that are aligned with their values, preferences and lifestyles – is called Shared Decision Making.

In honor of National Breast Cancer Awareness Month this October, Health Dialog is making its Shared Decision Making and planning aids on breast cancer publically available throughout the month. The early stage breast cancer and breast reconstruction surgery decision aids help guide patients through all stages of the decision making process, from explaining how to read a pathology report to illustrating what a patient can expect from different types of surgeries. Health Dialog also offers planning aids for patients and families who are having needle or breast biopsies to prepare for what will happen before, during and after the procedures.  All of these aids and resources can be accessed by clicking here.

The Shared Decision Making process aims to give patients the care they want and nothing more. The process involves patient use of shared-decision making aids with constructive discussion between the patient and a healthcare provider. Shared decision aids come in various forms—print, online and video—and are designed using clear and simple language in order to prepare all people to participate in their health care and health care decisions. They provide balanced information about options and outcomes from the patient’s point of view and help the patient clarify their own personal values. Patient decision aids are designed to complement, rather than replace, counseling from a healthcare professional.

So, as we come together for a good cause this month, let’s all remember the patient and the fight they are each individually undertaking. By putting the tools and resources they need at their disposal we help them feel a little more confident.

Peter Goldbach, MD, is the Chief Medical Officer at Health Dialog, a leading provider of healthcare analytics and decision support. He has 15 years of experience in medical administration and 17 years maintaining a primary care and pulmonary disease practice. He received an undergraduate and master’s degree from UCLA and his medical degree from SUNY Downstate Medical Center College of Medicine. 

Out-of-network Medical Costs Affect Everyone

October 5, 2013 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Debt, Member Stories

According to a survey this year by America’s Health Insurance Plans, 12% of all medical claims received by insurance carriers were out-of-network in 2011. That translates into huge out-of-pocket costs for American consumers, and sometimes uncapped costs. Out-of-network charges can be nearly 100 times (100 times!!) the rate that Medicare allows (typically you will be no more than 2 or 3 times the Medicare rate with insurance).

Don’t think any of that applies to you because you have good insurance? Think again.

Excessive out-of-network fees are typically not covered by your insurance carrier to the full extent, and are often not applied to your deductible. This means you could not only be on the hook for large fees for some services, but those amounts could be uncapped, the equivalent of being uninsured, even while having a very good insurance plan. New Obamacare plans don’t solve this, as they are not required to cap out-of-network charges. And almost all carriers are shrinking their networks further for new exchange plans. How did this slip through the Affordable Care Act?

Health insurance carriers negotiate rates with a number of physicians and hospitals to get lower rates with its plan holders. These providers and facilities form a health plan’s “network”. When patients go to providers “in-network”, the insurance carrier pays significantly less. It is reasonable then that a plan might want to discourage you from going with a provider not in that network. It is also reasonable for a carrier to remove all but the lowest-cost providers from its network over time. The ACA also wants to keep people away from the highest-priced providers, in an effort to reduce healthcare costs overall.

The trouble is, sometimes going out-of-network is the best or only way to ensure critical healthcare. Specialists and key facilities in various parts of the country may not have a relationship with your carrier. There are also many cases when you end up receiving services from an out-of-network provider because of the nature of integrated care by professionals from a number of different companies. For example, even though you know your physician and hospital are in-network, you may not think to ask if the anesthesiologist is.

The 12% figure will surely rise under the ACA. More individuals will find that their preferred doctor is no longer in their plan’s network. Employers are beginning to cut spouses and children from plans, which will add to the confusion about which doctor you should be going to for which family member.

Some of the largest carriers like UnitedHealthcare and Aetna will only cover out-of-network fees up to what they consider a “fair” amount, and then you have to pay the rest yourself, even if you’ve already met your deductible. Good luck finding out what the cost will be beforehand. Doctors and nurses don’t know, and many facilities are known to not provide that information even if you call their billing department.

For more information on out-of-network services and payment, see FairHealth’s website. You can also see the websites of UnitedHealthcare and Aetna on how they deal with out-of-network costs.

 

Randy Cox
Founder & CEO of Pricing Healthcare

The Increasing Importance of SDM and Patient Choice in Today’s Healthcare

October 4, 2013 in Member Stories

A recent report (September 2013) from the Center for Disease Control and Prevention (CDC) stated that through effective public health measures, necessary screening and medical care, and lifestyle change, at least 200,000 deaths from heart disease and stroke each year are preventable and that more than half of preventable heart disease and stroke deaths happen to people under age 65.

In the study, CDC officials go on to say that the Affordable Care Act (ACA) will be helpful in reducing avoidable death by providing medical treatment and screening facilities to a large number of uninsured Americans.

Providing up to 29 million new people with affordable health insurance by 2019 is a good start. However, the key to success goes beyond simply providing access to health insurance. It will depend on how effectively plans and employers can actively engage people in their healthcare and the decisions about their health. Engagement can be done through unique and compelling online and offline educational methods including web-based information about conditions and treatment options, DVDs, telephonic health coaching, and/or any combination of those. Through this engagement, patients are empowered with the tools, resources, and information they need to have informed conversations with their doctors and make the decisions that are best for them based on their values and preferences. This is Shared Decision Making. And, it has been proven to improve patient and provider satisfaction, reduce hospitalizations and invasive surgeries, and improve patient outcomes while reducing costs.

By incorporating Shared Decision Making into patient education services, health coaching, and wellness programs, plans and employers can drive true behavior change by helping patients make healthy lifestyle choices and address chronic conditions, such as heart disease and stroke.

As the healthcare industry continues to evolve and the ACA takes hold, Shared Decision Making can play an important role in driving an informed patient. And, an informed and engaged patient is critical to a better system.

Peter Goldbach, MD, is the Chief Medical Officer at Health Dialog, a leading provider of healthcare analytics and decision support. He has 15 years of experience in medical administration and 17 years maintaining a primary care and pulmonary disease practice. He received an undergraduate and master’s degree from UCLA and his medical degree from SUNY Downstate Medical Center College of Medicine. 

Just asking “How much will this cost?” makes a difference

October 2, 2013 in Member Stories

I had an awesome hour of squash with some old friends over the weekend.

Three days later I’m gritting my teeth through spasms in my lower back.

So I go see an orthopedist, or actually, his physician assistant.  She orders x-rays.  I assume that means one and ask, “How much will it cost?”  She looks at me with surprise.  Well, she says, if you’re worried about the cost we’ll justrun two.  We usually order a package of five, but you probably don’t need the five anyway.  I’ll look at the two and if I need more, we’ll take them.

How much did I save the system? Probably not more than a couple hundred bucks.  And I won’t get a share of the savings, but then I didn’t get any unnecessary radiation either.  A win all around, sort of.

I’d never met this PA and it didn’t fell right to suggest that she ask herself every time, does my patient really need five x-rays?  But I wonder: how often would asking about the cost make a difference in the treatment we receive.  My guess is, often.

 

 

 

Reframing Healthcare in the Minds of Younger Americans

August 27, 2013 in fitness, health care costs, health care quality, Health Insurance, lifestyle, mental health, nutrition

The clock is ticking towards October 1, 2013 when public insurance exchanges are set to go live and begin offering health plan benefits to an estimated 30 million previously uninsured Americans. And as that day draws closer, all parties involved—plans, providers, employers, and patients—are scrambling to figure out just what it will mean to them from a cost and quality of care perspective. Yet, perhaps one of the biggest conundrums associated with the health insurance marketplace is how to deal with the potential sticker shock facing younger Americans and the ripple effect it could have on everyone. Specifically, with an age band as narrow as 3:1, there is a possibility that premiums for younger people (who tend to be lighter users of service) will be considerably higher in order to compensate for older Americans, who typically utilize more health care services. When combined with a relatively low penalty for not getting coverage, there is a very real fear that many of these ‘young invincibles’ will forgo coverage and simply choose to pay the penalty.

So, the question becomes, ‘how do we articulate the value of health coverage to this younger generation?’ or, in other words, convince them that coverage is relevant (and worth it) to them?

We need to help this younger population understand and believe that healthcare is not solely about supporting the sick – support is also critical for the well. For example: a recent college grad that is just starting out in his/her career and may have issues dealing with the stress of that new job; the twenty-something who runs marathons but wants to improve their nutrition; the new mother who wants to start a workout program to shed some of the baby weight; or the avid skier who suffers a knee injury on the slopes and wants to understand what treatment options are available to them.

These scenarios play out each day across the U.S. and could happen to just about anyone between the ages of 18-35, not solely older people or those with chronic conditions. And there are programs, resources and tools focused on shared decision making and wellness that are critical components of modern healthcare that young people can take advantage of. So at the core, the solution for this current dilemma needs to be about making the younger population aware of these resources because they support behaviors that contribute to better health and wellbeing. Specifically, we need to create a  culture that encourages all people—including the younger population—to think differently about their health, make more informed choices, and understand not only the resources at their disposal but also the value they provide.  If we can do that, we will go a long way in positively impacting the health and wellness of these younger generations and controlling spiraling healthcare costs.

Robert Mandel, MD, MBA, is the CEO of Health Dialog and has more than 15 years’ experience in senior leadership positions in health systems and health plan management. 

Patients Exposing Medical Prices, Taking Matters Into Their Own Hands

August 14, 2013 in health care costs, Hospital Bills, Insurance Bills, News

The medical world is moving toward price transparency — very slowly.  Unfortunately the amount of data available is still relatively sparse, considering the wealth of useful data that could be published. What users are shown is often nothing more than an average or calculated estimate for an area.  When the rare facility-specific data is revealed, it is too often list prices (which almost no one pays) or several years old.

One reason for the crawling pace is the healthcare industry’s reticence to let consumers compare costs, which would surely send a great deal of business to lower-priced facilities and put downward pressure on prices.  It would be disastrous to their revenues.  And don’t think for a minute that the federal government is in a hurry to bring about transparency. The “Affordable” Care Act was carefully crafted to keep hospital revenues in tact, influenced by the billions politicians receive from healthcare lobbyists (more than 4 times greater than the next 3 largest lobbying groups combined). Patients just don’t stand a chance against such powerful forces.

Enter Pricing Healthcare, a relatively new addition to the playing field. They’re asking consumers for a little (anonymous) pricing data from their medical bills in an effort to expose what should be openly and readily available to patients. The company is interested not just in the prices hospitals and physicians charge, but more importantly what real patients are actually paying, in the form of discounted and insurance-negotiated rates. Users can enter data from bills going back nearly 3 years, but as people enter more recent data, it keeps the content current. The website makes the process relatively easy, and patients from all over the U.S. have already started submitting data, many with a great deal of enthusiasm.

Crowd-sourcing isn’t Pricing Healthcare’s only source of price information on the user-friendly site. While consumer data is being collected, the company is also pulling in data from other sources (as can be seen from the large amount of San Francisco data they have published). For the first time the company says, consumers can compare cash prices for scores of hospitals in a large metro area. They company is asking patients in the San Francisco area to help them discover insured rates (the hardest prices to come by) by supplementing the data already on the site from their own medical bills.

Grass roots efforts have done a great deal to influence the course of American history. The internet age certainly makes it easy for individuals to band together and force change. Pricing Healthcare hopes citizens will be concerned enough about the high cost of healthcare to lend their voices and make a difference. Time may be running out.

 
For more information, visit https://pricingHealthcare.com, or send the company a message at https://pricingHealthcare.com/contact.
 
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by HCSavvy

Valiant effort to persuade the young invicibles…you need health insurance

August 14, 2013 in Health Insurance

Picture 11This guy is definitely going do some damage to his back – hard to say how much and where.  The MRI alone could cost more the penalty he’d pay next year for not having insurance.  But will the young invicibles sign up?  It’s going to be tough sell.

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Is caffeine withdrawal a mental health issue?

August 11, 2013 in lifestyle, mental health

Brietta’s graphic begs the question, are the effects of too much caffeine and the withdrawal messing with our mental health?

The American Psychiatric Association says it’s time for some rigorous research and has included caffeine withdrawal in its latest Bible, the DSM-5.  Here’s why:

Picture 10 Click here to play the video

Is America a Nation of Java Junkies?

August 10, 2013 in Member Stories

Is America a Nation of Java Junkies?
Source: Top Counseling Schools

What Really Drives Up Health Insurance Premiums

July 19, 2013 in Health Insurance

Every year it seems that we are paying more and more for health insurance. According to an informative infographic Carrington College, the health care costs in the United States have grown 2.4 percent faster than the GDP, meaning that as of 2010, people were paying more than 8,000 dollars per person, and that money represented about 18 percent of the United States’ economy.

There are several factors, which have contributed to the rising price of health insurance. For example, one benefit which has had unexpected costs is the medical technology that is now being used. The technology that is used to diagnose and treat illnesses accounts for at least 50 percent of the growth of medical expenditures since the 1960s, putting an increased burden on the people paying for their health insurance.

Another factor that affects the health insurance rate for most people is the failure to use a primary care physician. With more people only going to see doctors for emergencies, there is actually less money being spent on primary care doctors, a practice which has been shown to lower costs. In comparison with other industrialized countries, the United States spends three to six times as much money on specialist doctors.

There are many factors that tie into the rise of health insurance costs, including things like medical billing fraud and an aging population, so check out this informative infographic to learn more about what really drives up those premiums.

(Click to enlarge)Why is Health Insurance So Expensive

 

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If you’re shopping for the best place to get a new hip or knee…

July 17, 2013 in health care costs, health care quality, Hospital Bills, Medical Care

take a look at this article.

You can pay $23,000 for the highest quality hip, knee or ankle or, if you prefer, spend $64,000 for the lowest quality procedure in Boston, according to an analysis from Castlight. In Washington, D.C., the cheapest top quality operation is $30,000 as compared to $69,000 for the most expensive low quality job.Picture 2

Picture 3

Many of us routinely opt for the most expensive option, assuming more expensive equals better.  There’s a growing body of research that proves us wrong, but changing that association (the Nieman Marcus effect) is really hard, especially since we don’t usually have to pay the difference.

In NYC and LA higher quality joint replacements do cost more than the lower quality procedures.  What gives?  Are patients there smarter shoppers?

Picture 4

Another example of the insanity of “pricing” in the US health care “system”

July 16, 2013 in health care costs, Health Insurance, Insurance Bills

A family member had some lab work done by Quest Diagnostics, which is under contract with Harvard Pilgrim Health Care, our health insurer.  Because we have a high deductible plan, we were expecting a bill.  No problem.  The bill comes and it lists each test’s CPT Code along with a description – although admittedly I have no idea what these tests are – as well as the “charge” the “insurance discount” and a column that indicates “patient owes,” among others.

Here’s what was listed on the laboratory invoice:

Date CPT Code Test Description

Charge

Insurance Discount

Insurance Paid

Medicare/ Medicaid Paid

Patient Paid

Patient Owes

05/29/13 86036 ANA SCREEN, IFA

78.00

05/29/13 82784 GAMMAGLOBULIN

$56.15

05/29/13 83516 TISSUE TRANSGLUTAMIN

$157.04

05/29/13 83516 GLIADIN (DEAMIDATED)

$227.76

05/29/13 86039 ANA TITIER

$44.72

06/26/13 ADJUSTMENT

($483.20)

$563.68

(438.20)

$0.00

$0.00

$0.00

$80.48

 

I called Quest to get an explanation about the invoice.  In particular, I didn’t understand what they meant by “Insurance Discount” vis-à-vis the “Charge.”  After some back and forth, it was explained that the insurance discount is the difference between what Quest charges someone without insurance – i.e., their “list” price – and the amount that Harvard Pilgrim pays them for the test.  In my instance, it’s the difference between what I would pay if I didn’t have insurance and the amount that I owed because we’re covered through Harvard Pilgrim.

Their so-called charge for these services – the amount that they would charge me if I were to walk in off the street and get some routine blood work done – is more than SEVEN times the amount that they charge my insurance company.  Read the rest of this entry →

June 24, 2013 in Member Stories

 

I asked a couple of questions concerning healthcare costs and electronic health records and the fact that EHR’s are not lending themselves to effectively coordinate care among hospitals.

Click on the Thumbnail to view the questions – or view

The Full Clip

 

Stress and Your Health

June 24, 2013 in Member Stories

Stress and Your Health
Source: Best Psychology Degrees

Where’s the best? Prices in health care mean nothing unless you answer that question first

June 4, 2013 in health care costs, health care quality, Member Stories

The New York Times makes a strong argument for paying more attention to the price of a colonoscopy: “Colonoscopies Explain Why the US Leads the World in Health Expenditure.

But most Americans will be very uncomfortable choosing the cheapest test unless there’s proof the quality is just as good as the more expensive options.

(ex_magician/flickr)

(ex_magician/flickr)

But here’s where health care information breaks down. If you think it’s hard to find the price of colonoscopy – finding out who provides the safest, most reliable test, is close to impossible.

I, with the help of some brave docs in Boston, put together a sample chart.

There’s a much better example of how to shop for a quality colonoscopy here, from the folks at Quality Quest for Health.

Until someone can tell me where I can get the best colonoscopy, I’m going to resist shopping based on price.

Exercises to ease back pain

May 15, 2013 in fitness, health care costs, lifestyle, Member Stories

I’ve always been a money-saver  When I was younger, my mom looked in wonder as I handed her my birthday money and asked her to put it in the bank for me. I might not have had a Razor scooter like all of the other kids, but hey, I was able to pay off a third of my college loans before I even graduated. This frugal attitude has lead me to believe that I can save money in any situation, even when it comes to my health.

Photo Credit (www.mybackpain.info)

I still go to the doctor when I have to (broken bone, the flu, etc.), but if I ever see a chance to avoid a trip to the doctor, I’ll take it. A couple of years ago I hurt my upper back when I was playing in a rugby match (poor choice of sport), and now I have a tight muscle that flares up every now and then. When the injury initially occurred, an athletic trainer told me that I could get an MRI, but that it wouldn’t do much for me. In a nutshell, the MRI could possibly reveal what was wrong with my back, but even if it did, the doctor would probably recommend the same thing that I could have come up with on my own: exercise.

According to an article on Health.com, Read the rest of this entry →