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Avatar of Adrian Gropper MD

by Adrian Gropper MD

Your health data could be worth over $3,000 / year

October 21, 2012 in health care costs, Health Insurance

In a recent post about the new MA Health Information Exchange, I suggested that a patient-accessible connection to the HIE could save a patient thousands of dollars per year. And now there’s a real-world, peer-reviewed example of what we/’re talking about. Research of medicare Part D beneficiaries published in October 2012 issue of Health Affairs (sorry, it’s paywalled) shows:

“Nationwide, beneficiaries on average spent $368 more annually than they would have spent had they purchased the cheapest plan available in their region, given their medication needs. More than a fifth of beneficiaries spent at least $500 a year more than they needed to.”

and

“Our findings suggest that beneficiaries need more targeted assistance from the government to help them choose plans, such as customized communications about the most cost-effective plans that would cover their medication needs.”

Prescription drugs, as covered by Part D, represent about 10% of the nation’s overall healthcare cost. If, as a gross estimate, we took $368 from this study to be 10% of what a person would save if their overall health insurance was appropriate to their specific needs, then the annual per/beneficiary saving would be over $3,000.

To save this kind of money, patients will need to be able to pay an accountant or similar trusted advocate to match their specific health care costs Read the rest of this entry →

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Avatar of Lee Ostrander

by Lee Ostrander

What is going on with some familiar OTC products?

October 19, 2012 in health care costs, News

I have noticed that a number of familiar OTC drug store products are difficult to come by for the last several months, including Maalox, Triaminic, Lamisil, and seemingly much more.. Looking online, I see that production was suspended by Novartis in Lincoln Nebraska and Boucherville Quebec due to some troubles, according to reports.

http://www.fiercepharma.com/story/novartis-pulls-otc-meds-made-troubled-plant/2012-01-09
http://www.fiercepharma.com/story/novartis-pulls-otc-meds-made-troubled-plant/2012-01-09

The company is apparently just fine for a considerable length of time without these products, thank you, because for example, sales from Lincoln plant production are reported to have been less than 2% of Novartis sales.

I am not a big consumer of these products but have used some, and have found them to be of occasional positive benefit.  Now that they are not available, I ask myself if I have actually been wasting my money buying them.

In an online search, the most recent news as to what is going on appears to be a local report from way back in Mar 2012.   I can’t find any information on when the previous availability may return.

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Avatar of Lee Ostrander

by Lee Ostrander

Hospital cost infographics

October 19, 2012 in health care costs, Hospital Bills, International Health Care

We already know about spiraling health care costs, but more information doesn’t hurt.  Here is a comparison with other industrialized countries.  The data is from a group affiliated with GWU’s School of Media and Public Affairs.  The direct link is here. A shorter summary is here.

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Avatar of Adrian Gropper MD

by Adrian Gropper MD

MA Health Information Exchange Live Today

October 16, 2012 in health care costs, Member Stories, News

Our new health information exchange went live today starting with the ceremonial transmission of Governor Patrick’s health record from one hospital to another. The best description of the event is on John Halamka’s Blog today and yesterday. The exchange is interesting to the healthcaresavvy for a couple of reasons including its Direct secure email roots and future tie-ins to payment reform.

The Massachusetts Health Information Highway (the HIway) is based on the Direct secure messaging protocols mandated as part of federal EHR Meaningful Use Stage 2. As of 2014, all electronic health records that are eligible for federal incentive payments will have to send and receive Direct messages. Although patients do not have access to MA HIway yet, patients do have access to Direct messaging. Microsoft HealthVault offers free Direct email addresses, for example. I don’t know how long it will be before your doctor can send your health record to your Direct email address but there’s no fundamental reason it could not be done today using the MA HIway. Having your doctor receive a secure message from you, the patient, is also technically now possible. The questions of spam filtering, reimbursement and the doctor’s liability in receiving possibly unsolicited messages from patients (and, for that matter from other doctors) remain to be sorted out.

The tie-in to payment reform will come in future enhancements to the exchange. Read the rest of this entry →

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Avatar of Martha Bebinger

by Martha Bebinger

Check This! @amandapalmer’s #insurancepoll

October 16, 2012 in health care costs, Health Insurance, Insurance Bills, Medical Debt

As you read this, there’s a fascinating conversation about health insurance in America and abroad taking place on Twitter and on musician Amanda Palmer’s blog. It’s an outpouring of stories about medical bankruptcy, asking a friend to stitch up a deep finger wound, skipping medications and losing loved ones who couldn’t afford needed care.

The conversation started shortly after Palmer read Nick Kristof’s column about a college buddy with stage 4 prostate cancer, cancer he didn’t catch sooner because he didn’t have health insurance.

Palmer decided to poll her 698k Twitter followers about their health insurance, She asked these four questions:

1) COUNTRY?! 2) profession? 3) insured? 4) if not, why not, if so, at what cost per month (or covered by job)?

Palmer has a couple of volunteers now tallying the results, which keep coming in (check the hashtag #insurancepoll).

Many of Palmer’s followers live in Germany, the UK or France and are baffled by the stories on Palmer’s blog about the cracks in the American health care system.

In Massachusetts, Read the rest of this entry →

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Avatar of Sue (Sunni) Patterson

by Sue (Sunni) Patterson

Share Your Medical Bill Story in 2012 Cost of Care Contest

October 15, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Member Stories

In listening to you, we’ve found, time and time again, that outrageously high medical bills are not a rare occurrence in this country. Many glitches and loopholes in today’s American health care system often leads to unexpected, mysterious billed amounts that threaten individual families and force many Americans to the brink of bankruptcy or worse. But too often, those with serious medical financial problems have no outlet for their rage and consternation.

Now, a non-profit consumer advocacy group called Costs of Care is sponsoring a contest that’s based on listening to the American patient – yes, you! Anyone who has ever had to deal with a surprise high-dollar bill for medical care is invited to participate.

The Costs of Care 2012 Essay Contest provides a listening ear for struggling Americans, and even a chance to win a portion of $4000 in cash prizes. Contest creators seek “anecdotes,” not policy positions, about big medical billing problems, and “high value healthcare decisions.” Judges include former U.S. Secretary of Health and Human Services Donna Shalala and other panelists, including doctors and health care officials. The deadline for this contest is November 15, so would-be contestants have just a short time to send in their stories of up to 750 words for consideration.

What’s behind the Contest

In soliciting stories from American patients, Costs of Care and other participants are seeking to put needed pressure on today’s community of medical providers. Read the rest of this entry →

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Avatar of Amy Lischko

by Amy Lischko

An unusual medical encounter

October 10, 2012 in health care costs, Medical Care, Member Stories

My son was diagnosed at age one as having life threatening allergies to peanuts. He was given skin tests after what appeared to be a reaction to peanut butter. The tests showed he was allergic to everything. So, we spent the next 14 years religiously keeping him away from all nuts. Being an underutilizer, I never took my son back for further testing as given his history of asthma, it was unlikely he would outgrow this allergy. And, he never had another reaction. This summer (at age 15) my son went on a canoeing trip in the adirondacks…..miles away from any medical facility. To my shock, it was here that He decided he had had enough of his “special diet” and gave himself a “food challenge” by eating two peanuts. What happened? Nothing. When he proudly announced that he was no longer allergic to peanuts upon returning home, I was ready to murder him. How could he take such a risk? But, after calming down, I also wondered what had happened. Had he been misdiagnosed as a baby? Had he outgrown his allergy? Both his skin and blood tests provided evidence that he has this allergy, didn’t they? We made an appointment with a specialist, someone who could answer all our questions.

This appointment was really what I wanted to write about. Those who know me know that I am an underutilizer of health care services. So I was leery seeing this specialist. Would he want to run a zillion more tests? Would they want my son to undergo another food challenge? Well, not this allergist. Read the rest of this entry →

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Avatar of Martha Bebinger

by Martha Bebinger

Gold-plated stitches with a ruby stud

October 8, 2012 in health care costs, Hospital Bills

Remember that story about my colleague who got an $1134 bill from Mount Auburn Hospital for two stitches?  Turns out that total didn’t include the physician’s charge: $364.

So those stitches were $799 apiece.  My colleague cut her finger on the job and has been told she’s on the hook for these bills until the workers comp claim is approved. She doesn’t want to pay and have to deal with seeking reimbursement, but is worried now that the bills will go to collection.  Messy. Expensive. Annoying, just for two stitches.

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Avatar of Martha Bebinger

by Martha Bebinger

Sticker Shock: an $8,000 MRI?

October 1, 2012 in health care costs, Hospital Bills

In June and July, I had a series of migraines.  I chalked them up to stress and a lack of sleep but I went to see my doctor just in case.

I spoke to my colleague Sacha Pfeiffer about my attempts to shop for an MRI based on price.  I ended up at a hospital I thought would be moderately priced.  Last week, when I got a bill for $7,468 (plus an additional charge for reading the tests), I was stunned.

I only have to pay $25 of this and my insurer, Blue Cross won’t pay this total either.  If you want to hear more about why this charge is so high, listen here.

Have you had a “sticker shock” moment with a health care bill?

 

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Avatar of Sue (Sunni) Patterson

by Sue (Sunni) Patterson

How to Protect Yourself from Higher Than Expected Medical Bills

September 28, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care

If you are insured and visit your local emergency room at a hospital network in your area of residence, you expect to pay the stated co-pay that shows on your insurance card, right? This is, in some senses, a reasonable expectation, but it’s not always what happens. News media outlets around the country have aggressively broadcast many cases where huge out-of-network charges for secondary providers have led to excessive medical billing amounts for patients who simply visited the wrong hospital at the wrong time.

The Problem: Hospital Network Staff Outsourcing

This major problem, that results in more out of pocket dollars than expected, really has to do with how hospitals staff. Hospitals may simply bring in outside doctors, nurses, technicians and other staff who aren’t effectively on staff at that facility, in order to help fully staff an emergency room or other hospital department. This is a convenient fix for hospitals, but what’s enraging is the idea that hospital administrators don’t think about the dramatic impact that out-of-network charges can have on patients.

What happens with out-of-network charges is that when outside physicians or other staffers happen to provide care to a particular patient, that patient is simply billed for the balance of that care because of an automatic insurer denial. Insurance companies won’t usually pay for the work of out-of-network professionals, but hospitals hire them anyway. Read the rest of this entry →

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Avatar of HCSavvy

by HCSavvy

Snapshot: What’s driving up health care costs

September 25, 2012 in health care costs, News

The Health Care Cost Institute‘s latest report says spending started rising again last year after slowing for 2009 and 2010. Here’s the Institute’s snapshot illustration of why:

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Avatar of Sue (Sunni) Patterson

by Sue (Sunni) Patterson

What Factors Are Important to You in Choosing Your Doctor?

September 14, 2012 in health care costs, Member Stories

When business analysts take a look at the health care industry in America, they often find both striking similarities and radical differences between what consumers say about retail and what patients say about health care. Studies on health care services underscore the fact that a doctor’s office is, in many senses, a business, even though people don’t tend to think of health care as a “consumer industry.” New studies are finding that when it comes to choosing doctors, consumers are using some of the same criteria that they would at the check-out register of a department store or other retailer.

A Friendly Experience

Some of the newest results on surveys of patients as customers come from PwC Health Research Institute, a group that surveyed several thousand patients to get a better picture of what today’s patient is looking for in a medical provider. Part of what PwC found is that a friendly greeting is twice as important at the door of the doctor’s office as it is in a bank or a big-box store. That’s big news for practices that haven’t invested the time and effort to make sure there’s someone personable sitting at the front desk. It’s also a good look at how medical offices can tune in to what patients really expect in today’s health care industry.

Price Not a Factor?

Studies also routinely find that price is not the big factor in patient provider selection that it is in retail. Read the rest of this entry →

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Avatar of Dianne M. FInch

by Dianne M. FInch

My Knees in 3D

September 11, 2012 in health care costs, Member Stories

I’m not one to complain about new technologies. In fact, I’m a certified geek and always enjoy digging into something new and interesting.

But recently, following a claustrophobic journey into an MRI capsule to have my knees imaged, I found myself thinking about healthcare costs and how some technologies drive prices up.

After listening to magnets clang for about 20 minutes, I left the contraption, got dressed, brushed my hair, and attempted to keep any thoughts about surgery at bay.

I walked out to the reception.

“Do you need anything,” I asked the receptionist, knowing that I have new healthcare insurance that forces me to pay out of pocket until a deductible is met.

She looked on the computer. “We’ll bill you,” she said.

“Do you know how much it will be,” I asked.

“No,” she said.

I said “thanks,” and began to walk away.

“Oh, don’t forget this” she said, handing me a DVD.

“What is it,” I asked. Read the rest of this entry →

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Avatar of Martha Bebinger

by Martha Bebinger

Give us your waste, get a free mug

September 7, 2012 in health care costs, Member Stories

The Institute of Medicine says $750 billion, yes billion, of what we spent on health care in the US in 2009 was waste. Tell us your story about unnecessary or inefficient care, poor prevention, prices that were too high, etc. and we’ll send you a WBUR mug.  It will be useful for years ( OK, if you’re careful).

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Avatar of Sue (Sunni) Patterson

by Sue (Sunni) Patterson

Will Medicare Changes Result in Better Quality?

September 3, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt, Medicare

As the price of health care in America keeps rising, you may be among those that are frustrated by the kind of generic approach taken by  health insurance companies and government entitlement programs. The traditional fee-for-service format of health care reimbursement means that the best hospitals and doctor’s offices don’t get rewarded and the lower performing offices don’t have consequences. But, this is all likely to change with new Medicare rules that are slated to pursue more of a ‘meritocracy’ in the way that health care dollars get paid out.

New Medicare Rules

Reports from the Centers for Medicare and Medicaid Services show that Medicare is going to begin making some changes in the way that it reimburses health care providers starting late this year. In what Medicare officials call a ‘value-based purchasing’ program, Medicare will consider various aspects of a provider’s operations in setting the reimbursement rates for that particular office. Key factors will include observation of outcomes, or in other words, whether the procedures and services performed at an office actually help patients to recover from illnesses and improve quality of life.

Responses to the Changes

For you, this represents a major change and a big potential edge in making sure you get what you deserve for the money, especially when you have out of pocket expenses. On the downside, though, some providers are arguing that hospitals and offices in rural areas, or those with other significant disadvantages, may be punished unfairly. Read the rest of this entry →

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Avatar of Sue (Sunni) Patterson

by Sue (Sunni) Patterson

How Much is Health Insurance Coverage Really Costing You?

August 30, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt, Medicare

Just when you think you have the health care business figured out, new reports come out showing even more dark details about how American patients are simply charged massive amounts of money for health care services on a pretty arbitrary basis.

The newest wrinkle in this story actually turns the conventional wisdom about payment for health care on its ear: where many assume that most uninsured patients get the highest bills, new reports are showing that, in many cases, the “cash-up-front” deals given to cash-paying patients may be as little as less than half of a contractually agreed price that the hospital would bill the insurance company. Why is this a problem? Because it means that many of those who pay high deductibles, premiums and coinsurance on a health plan may still be paying more for each service, visit or procedure than someone who doesn’t have any insurance at all. It also injects a huge monkey wrench into the now established idea that everyone needs health insurance to make health care affordable. On the flip side, if you have a high deductible but choose to self-pay a medical bill, how will you ever meet your deductible? This is particularly troublesome should you have a catastrophic event. Read the rest of this entry →

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Avatar of Sue (Sunni) Patterson

by Sue (Sunni) Patterson

Practice is Proactive in Patient Relationships

August 25, 2012 in health care costs, Health Insurance, Medical Care

The Commonwealth Fund’s 2010 study found that almost 50% of US adults were either underinsured or uninsured.  This is a 7% increase from 2007 for the underinsured population. It used to be that having coverage was simply enough. Today, however, having the right type of coverage and amount are key factors in choosing a plan. What happens when you don’t have coverage for a specific procedure? One forward thinking practice in the Chicagoland area takes the time to explain your options and provides the cash discount rate – up front. Before you even ask. That’s mightily refreshing given the lack of communication in many healthcare organizations. And, it’s a win win for both parties. The practice receives a bill paid in full without expending additional dollars in the collections process and the patient is educated a little bit more on how the billing and insurance process works. Let’s hope that more practices implement this customer service level in the near future.

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Avatar of Mitchell Gavillion

by Mitchell Gavillion

10 Essential Questions To Ask During Any Hospital Visit

August 24, 2012 in health care costs, Hospital Bills, Medical Care

The hospital can be a scary, intimidating place, especially if you don’t spend a lot of time there. Depending on why you may have ended up in the hospital, there are certain questions you’ll want to ask your doctor and the medical staff. Questions To Ask During a Hospital Visit

  1. Are all the signs normal? You’ll want to know about all your vital statistics. How is your blood pressure, body mass index and breathing?
  2. Details about your problem: Ask the doctor treating you what may be causing the problem that forced you to visit the hospital. Could there be more than one issue affecting your health? Being kept in the dark can help compound your stress and make visiting a hospital even more severe.
  3. Learn more about the tests: Some of the testing done in a hospital can be uncomfortable and invasive. Find out first how accurate the tests are for diagnosing an issue. How safe are the tests you’ll need to undergo and what could some of the side effects be?
  4. Get the facts after diagnosis: If you are diagnosed with a serious condition, find out what the next course of action will be. Ask about the long-term outlook and what treatment options are available.
  5. Ask about each treatment option: Find out what the pros and cons of each treatment option available to you. What are the risks associated with each treatment and how do they weigh against the benefits?
  6. Get the facts about pricing: Read the rest of this entry →

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Avatar of Martha Bebinger

by Martha Bebinger

Hey ACOs, what can you do for me?

August 20, 2012 in health care costs, Medical Care

I keep hearing that one day soon we’ll all be members of an Accountable Care Organization (ACO). These are big or biggish health care groups that include doctors, hospitals, labs, rehab and other things I need. The deal, as I understand it, is that I get everybody coordinating my care “under one roof”, but I’m not supposed to go outside that roof for care. I know, some ACOs let patients continue to have unlimited choice, but that doesn’t seem to be the model.

If I’m going to give up the option of going wherever I want, then what I get under that one roof better look pretty good. So, you ACOs out there, that are getting ready to sell me on your services, here’s what I’m looking for:

1) A primary care doc who responds pretty quickly to my calls, emails, texts or Skype (or has a fabulous nurse practitioner or physician’s assistant who gets right back to me). Someone who routinely asks how I’m feeling, not just whether my body is OK. Someone who makes eye contact and can explain what’s going on with words I understand.

2) A dentist who does the same (and who shares records with my doc.)

3) Evening and weekend office and lab hours.

4) An electronic medical record I can view at home and add to as needed. The record will show the prices of the tests or treatments my doctor recommends and the ones I receive.

5) A patient coach who will help me get a second opinion Read the rest of this entry →

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Avatar of Martha Bebinger

by Martha Bebinger

Routing out waste, one pair of crutches at a time

August 12, 2012 in health care costs

My colleague Deb has very active kids and a pile of crutches in her basement.  “It drives me crazy,” she’s told me several times, ” the doctors say don’t worry, we’ll just give you a new pair.” 

Deb isn’t giving up.  She’s starting handing out crutches to anyone who’s going in for surgery and knows they won’t walk out without assistance.  She just brought in this pair for a friend’s husband who’s having arthroscopic knee surgery.

I called a couple of hospitals to find out how much Deb is saving the system.

“How much do you bill insurers for a pair of crutches,” I asked. One woman said, “anywhere from $100 to $800, depending on the type of crutches.” Another billing office staffer said, “around $150, I’m not sure.”

So Deb will save the system several thousand dollars if she keeps handing out her gently used crutches. And then, if they get passed along again, well, who knows how much she’ll save. Of course, we can buy our own from the local drug store or the local big box chain for much less than what the hospital charges.

Either way you have to remember to bring the crutches with you when you go under the knife. But maybe this is what getting rid of waste in health care looks like, up close and personal. Hmmm, I wonder if all hospitals let you bring in your own?

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