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Medical Marijuana Healthcare Quandary

January 21, 2015 in health care quality, Medical Care, News

Media have given prominent attention in recent months to marijuana. The Boston Globe reported a few months ago that marijuana legalization is on the cusp of mass acceptance. The New York Times has called for repeal of marijuana prohibition. Voting residents of the Commonwealth of Massachusetts in 2012 were sufficiently comfortable with the concept of medical marijuana that a ballot initiative for its use was approved..

Consumers may deservedly question how the change can alter personal healthcare advantages or disadvantages. Many residents, and I include myself, started with little knowledge about how marijuana could be medically helpful. To first clarify terminology, marijuana is a plant, a vegetable, that has a traditional name of cannabis. When the plant is used for other purposes such as producing clothing or fuel, etc. it is called hemp. Parts of the plant can be psychoactive. Cannabis can grow naturally out of doors in many parts of the world.

The subject of marijuana is polarized among the populace, with many very negative and many very positive viewpoints, plus people in the middle who lack information. Due to recent opening up of information channels, the claims for medical benefits are becoming better known. These include pain relief allowing a person to function more normally while reducing the use of other medicines such as opioids and non-steroidal anti-inflammatory drugs, which may have serious side effects or be debilitating. In some cases, cannabis is reported to be unique among alternatives to bring about patient relief or cures.

Despite the November 2012 approval, the Commonwealth of Massachusetts has not provided dispensaries that would make cannabis available to its citizens. On the other hand, Massachusetts does have an accredited cannabis lab to which samples can be submitted to test for active ingredients and contaminants. With the testing, supplied cannabis can in principle be checked and tracked better than say, other vegetables such as those going to the dinner table.

In the face of the marijuana healthcare quandary created by change, other states seem to be taking the lead in speedily addressing and redressing issues of cannabis delivery..

[Final note of caution: The above post is background about non-traditional healthcare resources, with which consumers may wish to be informed for their own benefit. The post contains best efforts information on a nebulous and changing topic, and the poster asks that the post not be relied upon for ultimate accuracy.]

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by HCSavvy

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

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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?

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Don’t let the doctors dissuade you

May 1, 2013 in health care quality, Medical Care, Member Stories

The Boston Globe recently reported that “Dr. Richard Aghababian, president of the Massachusetts Medical Society, believes rating websites present a skewed picture of doctors because patients are more likely to post about negative experiences.” This sentiment resonates with the results of a recently published survey conducted by the American College of Physician Executives, which was announced with the headline “Survey Finds Physicians Very Wary of Doctor Ratings.”

Dr. Aghababian’s belief is conventional wisdom — after all, who else besides disgruntled patients would bother to post a review? However, there have been a number of studies that disprove this notion. One study showed a median rating of 4.5 out of 5, while another study found that 88% of the reviews it looked at were positive. Curious about the subject, we at DocSpot (a free consumer website that helps people find doctors and allows patients to leave reviews) conducted our own study of nearly a quarter million online patient reviews and found that the majority of online reviews gave doctors the top score possible (5 out of 5). Is that the skewed picture that Dr. Aghababian was referring to?

To be fair, we don’t believe that online patient ratings give a comprehensive and accurate picture of doctors. We think that patient reviews are better indicators for certain aspects of care than others. “Is a doctor rude?” and “Does a patient feel rushed?” are questions that online reviews can lend insight into. Online reviews are also likely to alert prospective patients to other aspects of the experience, such as any unexpected billing practices. When people want to know “will I be healed?”, that’s a much trickier question. Read the rest of this entry →

The cost of prosthetics

April 23, 2013 in Medical Care, News

For the 14 people who lost at least one lower-limb during the bombings on Marathon Monday, learning how to incorporate a prosthesis, or a prosthetic leg, is in their near future.

The “C-Leg” prosthetic. Photo credit (

Simona Manasian, a rehabilitation doctor at Boston Medical Center, said that patients with amputations can be fitted with a temporary prosthesis two to three months after the injury took place. However, according to Paul Martino, the president of United Prosthetics in Dorchester and Braintree, the patients will not be fitted with a permanent prosthesis until a year later, when the residual limb has stopped changing in size.

Over the decades, there has been a rapid advancement of lower-leg prosthetics, such as a battery-powered bionic ankle designed by iWalk that simulates a more natural way of walking than other prosthetics, the “C-Leg,” which uses a microprocessor and a lithium ion battery in order mimic the movements of the knee, and the “Flex-Foot Cheetah,” which stores kinetic energy and was made popular by Olympian Oscar Pistorius.

A combination of various factors, such as type of prosthetic device, level of limb loss, and functional capability, means that not every prosthesis is going to cost the same amount. The Journal of Rehabilitation Research and Development released a study analyzing the prosthetic cost projections for veterans. Here are the estimated costs:

  • Partial foot ($14,187)
  • Ankle disarticulation ($16,356)
  • Transtibial, or below the knee ($16,690)
  • Knee ($45,563)
  • Tranfemoral, or above the knee ($45,563)
  • Hip ($45,633)
  • Transpelvic disarticulation ($49,208)


  • Oscar Pistorius’ “Flex-Leg.” Photo credit (

Review of free iPhone medical apps

April 3, 2013 in Health care apps, Medical Care, Member Stories

Nowadays there’s an app for everything, so it shouldn’t be too surprising that the medical world has converged with the app world to create apps that are marketed specifically towards patients. I decided to try out some of the top-rated free iPhone apps to see if they’re as user friendly as they claim to be, and I’ve picked out three of my favorite.

Photo Credit (

First Aid – American Red Cross

For me, this app from the American Red Cross is a must-have. Not only is there a section that informs you about common first aid procedures, but there is also an emergency button that you can press that has videos, pictures, and step-by step tutorials to help you in a medically related crisis. The only negative that I could come up with is that it might be stressful to read directions while you’re trying to help someone. Fortunately, the app has a “911” button under each procedure that instantly calls for help in the case that you cannot assist the person in need of help.


This app is ideal for patients who want to window-shop for prescriptions before they settle on the first one that they find. There is section called “Compare Rx Price” that allows you to type in your prescription and search for the lowest price at local and online pharmacies. It also has weekly deals, discount cards, and a pill identifier section. My favorite part of the app is the reminder that pops up on your phone to let you know it’s time to take your medication.

Pregnancy +

I might not be pregnant, but this app was rated number Read the rest of this entry →

Should Medicare fund sex change surgery?

March 30, 2013 in Health Insurance, Medical Care

I had a WOAH moment yesterday when I opened this email from a doctor who passes along developments in the exploding world of transgender health:

Medicare announced that beginning March 28, 2013 and for a 30 day period, it is inviting comments from the public regarding reconsideration of its current policy to deny coverage of sexual reassignment surgery.

Anyone wanting to recommend a change of this policy and to advocate for medicare covering sexual reassignment surgery, the website to go to is

Don’t bother trying to open the link. Less than 24 hours after the Centers

graphic courtesy of Wikimedia

for Medicare and Medicaid Services posted this announcement, they took it down. A spokesperson told The Hill the agency decided not to take public comments while a challenge to the agency’s policy is “working its way through the proper administrative challenges.”

Medicare and Medicare, and almost all commercial insurance plans, don’t fund surgery for men or women who feel like they were born into the wrong body.

So since Medicare can’t or won’t ask, we will:

Should Medicare and Medicaid fund sex change or gender reassignment surgery?

Robotic Surgery Warning!

March 21, 2013 in Medical Care, Member Stories

robotic surgeryRobot-assisted surgery is on the rise. If you’re thinking about it or your doctor is recommending it – Read This First.

In Massachusetts, the Board of Registration in Medicine says it is seeing an increasing number of “patient complications associated with robot-assisted surgery.”

Here’s one example:

The patient underwent elective robot-assisted laparoscopic hysterectomy and bilateral salpingo-oophorectomy, performed by two attending surgeons. After removal of the uterus, excessive bleeding was noted. Intraoperative colorectal and urologic consults found a significant length of the sigmoid colon mesentery damaged from incorrect tenaculum placement, left ureter dissection and cautery injury along the pelvic sidewall. The patient required laparotomy, sigmoid resection, diversion ileostomy and bilateral ureteral stents.

Paul Levy notes the obvious on his blog; this is more bad news for one of the major robotics manufacturers, Intuitive. Bloomberg reports on lawsuits mounting against the company for allegedly prioritizing sales over training.

So be prepared. If your doctor says she’s going to use a robotic device during your surgery, ask some questions:

1) Are you certified to use the robot?
2) How many surgeries have you performed with this particular device?
3) What’s your complication rate from surgeries using this robot?
4) What are the risks of surgery with and without the robot?
5) Is there any difference in cost?

Affordable Care Act looks to prevent chronic diseases in women

March 12, 2013 in health care costs, Health Insurance, Medical Care, Women's care

Like many people in the United States, I’m aware that the Affordable Care Act was signed into law by President Obama and that it aims to make sure that everyone has healthcare; however, until now I hadn’t taken the time to ask how it affects women like me. A quick glance at the services provided under the umbrella of the Affordable Care Act shows that there are a handful of preventive services that I never knew I should consider, let alone take advantage of.

photo credit (

One of the major elements of the act is encouraging women to visit their doctor in regards to preventive care services since, according to, chronic diseases that are often preventable are responsible for 7 of 10 deaths among Americans each year and account for 75% of the nation’s health spending. If the preventive services cut down on the percentage of people with chronic diseases, then the nation’s spending spent on health will presumably go down.

Some of the services offered to women are screenings for anemia, cervical cancer, gestational diabetes, gonorrhea, Hepatitis B, and osteoporosis. Additionally, in August 2011 the Affordable Care Act introduced eight new preventive care services for women including Read the rest of this entry →

Say goodbye to annual Pap smears

March 5, 2013 in Medical Care, Member Stories, Women's care

(photo credit,

Every year since I’ve turned 18 I’ve had a Papanicolaou test, also known as a Pap smear, to screen for cervical cancer. And every year it’s the same story. The cold, uncomfortable test takes less than two minutes, and then I’m sent out of the doctor’s office and asked to make an appointment for the following year.

Our recent post on the regularity of physicals got me wondering how often it’s suggested that females get a Pap smear. According to my family doctor, Dr. Marilyn Lange, women should get a Pap smear annually.

“If you’re having multiple partners, then every year,” says Dr. Lange. “If you’re in a stable relationship, then every two years. That’s my opinion.”

However, while Dr. Lange is in favor of women getting a screening every one or two years depending on their sexual activity, updated reports Read the rest of this entry →

Should annual physicals actually be annual?

February 26, 2013 in Health Insurance, Medical Care, Member Stories

I’ve been going to my childhood doctor every year for as long as I can remember. She’s helped me through the chicken pox, flu shots, ear infections, and the perils of puberty. But as my mom pointed out a couple of weeks ago, I’m now in my twenties, which is too old to still be going to a pediatrician. The nostalgia in me wants to scream, “No, you can’t make me go to a new doctor,” but the logic in me says, “I guess it’s time I go to a doctor’s office where the waiting room isn’t filled with Legos.”

My healthcare conscience mother and me.

My healthcare conscience mother and me.

But how urgent is it for me to find a new doctor for my annual physical? Here are the facts: I’m a 22-year-old female, I haven’t had a physical in almost 14 months, and I don’t believe that I have a serious illness that has surfaced since my last visit. Can’t I just skip a year and wait until I’ve found a new doctor that I like?

While my mom might say no, my pediatrician says yes. Dr. Marilyn Lange, a doctor in Los Angeles and a graduate of Tufts University School of Medicine, says that a woman of my age can get away with only having a physical every three to four years unless she has a medical problem. “There are definitely reasons to do it,” says Dr. Lange, “but if you want to skip a year, that’s fine.”

An article published by Duke Medicine supports Dr. Lange’s claim and says that how often you get a physical depends on your age and disease risk factors. Assuming you are healthy, the article suggests you get a physical every two to three years if you’re under 30, every one to two years if you’re between 30 and 40, and every year if you’re over 50.

Additionally, a Danish study released in 2012 found Read the rest of this entry →

The Need to Know is Powerful

February 6, 2013 in Medical Care

The following story is by Dr. Robert Fenster, a psychiatry resident based at Brown University in Rhode Island , and a winner of the 2012 Costs of Care Essay Contest.

“I’d really feel better if we got the MRI,” Ms. James said. “I understand you think it’s a migraine, but I want to know, just in case. Wouldn’t you?”

Ms. James and I sat in her darkened hospital room—the light bothered her eyes and exacerbated her headache. She was a dialysis nurse with many years of experience in the healthcare field, and I was a first-year doctor trying to convince her that she was most likely suffering from a migraine and did not need additional tests.

Ms. James had woken up the morning before with very concerning symptoms. Her head hurt terribly. She got out of bed, but she felt nauseated and had to lie back down. She thought she needed her morning coffee, but she felt too sick to go downstairs to make some. Her headache had worsened, and she began to notice shooting pains in her left arm. She was scared. A few hours later, her daughter arrived to find her mother’s speech was slurred. The daughter called an ambulance.

By the time Ms. James reached the Emergency Department, her speech had improved, but her headache remained. The fluorescent lights bothered her, and the loud noises of the hospital grated her nerves.  A neurology resident was called to evaluate her. He felt that she was most likely experiencing a migraine and recommended that she be given some medication to help with her pain. He thought it was possible that she could have suffered a TIA—a transient ischemic attack, in which the blood supply to a part of the brain is temporarily blocked—but he felt that this was a less likely possibility. He did not think she would need an MRI scan of her brain unless her slurred speech returned.

The craft of medicine requires doctors to constantly manage probabilities. Read the rest of this entry →

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by HCSavvy

Might as well laugh instead of cry

February 1, 2013 in Medical Care

These two gems are back to back in the latest issue of The New Yorker:

Preventing Child Medical Identity Theft

January 29, 2013 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care

Along with being able to talk to providers and insurance companies from an informed standpoint, you will also benefit from knowing more about how criminals work to fraudulently bill others for various items including health care services. There has been a flurry of reports about a growing practice that’s pretty disturbing, especially to new parents. It involves criminals simply using children’s identities to bill medical services and other items to credit accounts.

Doesn’t The Government Check a Consumer’s Age?

You would think that children would be safe from identity theft because of their age. But, the reality is that with the complex database systems of many governments and private businesses, it’s often possible for criminals to commit fraud by using the Social Security number and other identifying information of a minor. At the same time, many of these efforts are successful specifically because nobody else is checking the credit account for a minor. Since a child can’t usually make purchases or access his or her credit, everyone figures the accounts will be dormant. What some unlucky parents are finding out, though, is that to many government agencies and businesses, one Social Security number is as good as another, and the issue of age does not factor into many of these fraudulent accounts. In some cases, criminals who open these kind of accounts can keep using them for months or even years.

What To Do About Child Identity Theft

Much of what consumer advocates recommend in terms of deterring child identity theft is the same as what you would do to prevent adult identity theft. Read the rest of this entry →

Worked 40 years, now disabled, can’t get care – What Happened?

January 10, 2013 in health care costs, Medical Care

I have have a low back problem since 1992 when I became hurt at work. I needed a laminectomy @ L/4 L/5, I was fine for a while until my wife and I were rear-ended on the 91 frwy. in Orange County, Ca. 1997. Then my back slowly got worse. In 2003 I had a Dorsal Column Stimulator” inserted in my body, it worked for a while but in 1995 the battery died and they removed the unit. Although the Doctor removed the spinal lead implanted in T/6-T/7 area it still gives me problems to this day. I am now 57 and on permanent disabilty through (SSA).

I also started having stomach problems in 2009, serious doubled over pain like no other. I was diagnosed with chronic pancreatitis and have been hospitalized 3-seperate times for this issue. The medication I need is ”creon” and there is no generic brand so it costs $380.00 per month. I am now on Medi-cal which doesn’t pay anything because the government/county program thinks I receive too much money to qualify. So I have to pay for ”ALL” my medications. Thats over $600 a month, towards a $1512 (soc) or share of cost. That’s monthly by the way. What the hell has happened to our medical in this country? I have worked 40 years and did not want to be disabled, but it happened. Now I can’t get the medical care I need.

The Rise of U.S. Health Care Consumers: Lessons from Abroad

January 5, 2013 in health care costs, Health Insurance, International Health Care, Medical Care, Quality of care

Can you imagine buying gas from a station with no signs to let you know the prices? Or having the clerk at a clothing store pick the “right” jeans for you, with no opportunity to figure out for yourself which ones fit best? In a sense, this is how Americans buy something far more important: health care.

Economists and policy makers have long emphasized the challenges in treating health care as a consumer good. Supply generally drives demand; there is little correlation between cost and quality; and end users have neither visibility into costs, nor much incentive to find out. Lack of price transparency makes it nearly impossible to find health care cost information even for someone motivated to look for it. Consumers also have little basis for evaluating quality; often the data that is available is dense and hard to interpret. In other words, most Americans do not have the practice or capacity, let alone the information they would need, to make informed health care decisions.

But it does not need to stay this way – and, indeed, it cannot if health care reform is to succeed. Under the Affordable Care Act, 12 million consumers are expected to purchase their own health insurance via a health insurance exchange by 2014, growing to 28 million in 2019. Americans, including lower-income individuals qualifying for subsidized health insurance, will have new health plan choices, and new means of comparison shopping. Even without reform, health insurers are designing and employers are increasingly offering products that shift costs and choices to the consumer.

Remarkably, as a nation and a health care industry, we have not prepared our population for the increased responsibility and decision-making power they will soon assume. Yet there are places around the world that have a lot to teach us in this arena, and they’re not necessarily the ones you might guess – or the ones health economists tend to focus on. Read the rest of this entry →

I want information about costs AND quality

January 1, 2013 in Medical Care, Quality of care

I’ve been thinking about this push from e-Patient Dave to redefine and rename “transparency.”

“If I mention ‘transparency’ to people in my community,” says Dave, “most have no idea what I mean. But when I say ‘We need to see what things cost – and nobody can tell us,’ everybody does see what a problem that is.”

And so, says Dave, what we need is “Visible prices, please. Before we make our purchase decisions.”

OK – no disagreement. Transparency is one of those wallpaper words.  Everyone uses it; but it feels plastic.  And, I strongly agree that we can’t make wise spending decisions about where to go for care if we have no idea how much anything costs.

Huntington Hospital in Pasadena, CA is one of the few hospitals I know of that posts prices for procedures, based on your insurance coverage.

But cost is only part of what we, patients, need to see in clear, user-friendly terms.

The other critical factor in choosing where to go for care is QUALITY.  Which doctor or hospital will give me the best results after knee surgery or the best chance of catching problems through a colonoscopy or the best normal delivery?

I don’t think any of us want to get to the point where we are buying care based on price alone.  So transparency, or whatever we call it, has to help us decide where to get the best care at the lowest price.  So Dave – what do we call that?  Don’t say “value.”  Anyone?

Robo Wrong on Mammograms?

December 14, 2012 in Medical Care

I got my first health care Robo call last week.

It was from my insurer, Blue Cross, telling me that I was overdue for a mammogram.  Yes, it’s true, it’s been more than a year.  But that’s by choice.  In the heated controversy about how often women should have an MRI, I’m going with every two years.

Judy Norsigian and other women’s health advocates question whether women should get mammograms as a routine test at all.

So why is Blue Cross recommending annual tests? The customer service rep I spoke to today said she didn’t know. She thought that the reminders went out automatically to all women over a certain age.

It’s cool that Blue Cross is sending me reminders, although I was a little surprised that my robo gal didn’t have “don’t think I need an annual mammogram” as one of the reasons I could choose for being overdue.  Surely there are at least a handful of us who have taken the advice of an independent panel to heart.

Are Transparent Hospital and Medical Bills on the Rise?

December 3, 2012 in health care costs, Hospital Bills, Insurance Bills, Medical Care

News from an Ohio media news site indicates that “hospitals around the country” are trying to make their medical bills easier to read, citing the Healthcare Financial Management Association and a case study for the Cleveland Clinic, one site that has renovated the look of its paper bills.

Most of the changes focus on the idea that traditional bills just have too many lines and lack clarity about who has current responsibility for debt amounts vs. who has already paid. To this end, photos of new billing structures show that complicated sets of line items can be replaced with headings like “You Paid X on X Date” and “Insurance Company Paid X Amount.”

Changing the format for medical bills can help both you and your provider. Because when you can read a bill effectively at a glance, you are more likely to respond immediately to what you receive in the mail. Bills that are too cryptic often just end up getting thrown in the trash or added to the pile. This means the provider receives delayed payment or non-payment and you risk credit damage.

What These Medical Bill Improvements Don’t Address

Although it can be really helpful to make bills more readable, this still doesn’t address some of the most common challenges we encounter. Read the rest of this entry →

What’s a “good” colonoscopy?

November 23, 2012 in health care costs, Medical Care, Quality of care

No bad jokes.  I’m serious.

I’ve reached the wonderful age at which I’m supposed to have this test as part of my general health care.  I had one 10 or so years ago, so I know what I’m in for.  The best thing to be said is that the drugs gave me a deeply restful nap.

The first time, I went wherever my doctor told me to go.  This time, I have a couple of references from my doctor, but I’m going to ask some more questions before I decide whom will perform the delicate procedure.

I’ve talked to a few docs and looked at some websites.  Here’s my list of questions.  Is there anything I should add?

1)     About the prep – what will give me the best cleaning out with the least discomfort?  There’s no point in going through all this if the doc can’t see what s/he is doing.

2)     What’s the doctor’s detection rate?  One medical society (the American Society for Gastrointestinal

Borrowed from Asian Scientist where study found that 30% of colonoscopy patients had polyps.

Endoscopy) says a doctor should find a polyp in 25% of men and 15% of women (why the difference?), but I know that some physician groups around Boston say the average is 40-50% among docs who really look for polyps.

3)     How much time does the doctor spend, on average, on the test?  I think more is better, is that right?

4)     Does the doctor always get to the end of the colon? OK, I may not be able to ask this. Read the rest of this entry →

What is Being Done About Medical Billing Fraud?

November 19, 2012 in health care costs, Health Insurance, Insurance Bills, Medical Care, Member Stories

Over the last few years, healthcare insurers have been focusing on fraud detection. Their efforts have been undertaken with the cooperation of the National Health Care Anti-Fraud Association (NHCAA). The increasing numbers of suspected fraudulent medical claims are related to the economy, legislative attempts to help the consumer and general changes in ethical behavior. Also, a real danger exists because when medical service providers and attorneys are working in cahoots with fraudsters, prescribed treatment can be unnecessary and may even cause harm to patients.

The property and casualty insurance industry is also stepping up to implement fraud control. That’s because a significant amount of healthcare fraud starts with an incident related to property casualty insurance. For example, in the New York City area, about one in five no-fault auto insurance claims appear to contain elements of fraud. In addition, as much as one in three claims appear to be inflated.

Recently the National Insurance Crime Bureau (NCIB) asked leading property/casualty insurers to participate in a project to analyze medical billing data and place it in a single database. It is hoped that the ongoing participation of these insurers on supplying data for this project will enable the industry to be aware of emerging trends regarding potential fraud around medical billing. Read the rest of this entry →