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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.

Read the rest of this entry →

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.




Is America a Nation of Java Junkies?

August 10, 2013 in Member Stories

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

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.



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 (

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, Read the rest of this entry →

Do Not Covet Thy Neighbor’s Medicine

May 8, 2013 in lifestyle, Member Stories

Back in the day, sugar sprinkled with a spoonful of gossip was the typical commodity to share over the fence between neighbors and friends.  Perhaps if cooking or scandal was not your forte, then an innocent request for a snow blower may be on par.  Yet today, what is freely passing over neighborly coffees and talk of petunias is prescription medications whereby turning innocent backyards into outdoor pill dispensaries.

It is common to hear that we have become desensitized.  Typically desensitization refers to such offensive stuff such as violent carjacking video games, bad manners and daily mentions of ill at large.  Yet, we have also become immune to the dangers that lurk deep in the bowels of our own medicine cabinet and the quick impulse to dole out said medicine.  Perhaps in a neighborly gesture gone array, friends teeming with good intentions, offer their prescription meds to others in need of a pill.

Sharing we are taught is a good thing.  From days long before we can even remember, our mothers were reminding us and scolding us to share, share, share.  Share your favorite toy, share that half eaten cracker, share the remote with your brother.  Thus, it may only be succumbing to a natural instinct that to see a friend in need illicits a helpful response.  Urinary tract infection? Oh here are some unused antibiotics.  Stress at work or a big presentation coming up?  Here is some Adderall or Ritalin.  Wisdom teeth bothering you?  Here’s some Oxycontin.  Bad breakup?  Here’s a Valium. That’s what friends are for after all.

According to a Center for Disease Control and Prevention study, women 18 to 44 lead the trend.  Over 36% polled in this group, admitted that they have either lent or borrowed a prescription drug from a friend or family member. Read the rest of this entry →

Value of yoga

May 6, 2013 in fitness, lifestyle, Member Stories, News

I’ve never been one for yoga. My roommate has been trying to get me to go to a class with her for months, but I always tell her that I’m more of a cardio kickboxing type of girl. What can I say? I’d rather de-stress by punching and kicking the air than pose like a tree. However, I might now consider going to yoga after a recent study was released that claims yoga does much more than relax the body and mind; it can actually change the expression of genes.

Photo Credit (

According to a new study from the Benson-Henry Institute for Mind/Body Medicine at Massachusetts General Hospital (MGH)  and Beth Israel Deaconess Medical Center, “elicitation of the relaxation response – a physiologic state of deep rest induced by practices such as meditation, yoga, deep breathing and prayer – produces immediate changes in the expression of genes involved in immune function, energy metabolism and insulin secretion.”

The study consisted of blood samples from 26 healthy adults who had never participated in relaxation response practices. The samples were taken before and after they completed an Read the rest of this entry →

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 →

Who rates medical apps?

April 12, 2013 in Health care apps, Member Stories

With so many apps available to patients, at first glance it might be hard to tell which ones are useful and which ones will just eat up space on your phone. To save people the trouble of wasting money and time on an app, several websites have reviewed some of the top medical apps on the market so that you don’t have to.

iMedicalApps, a site that claims to be ”the leading online publication for medical professionals, patients, and analysts interested in mobile medical technology and health care apps,” has physicians, health professionals, medical trainees, and health analysts review medical apps.The best part of this site is that the reviews leave nothing to be asked. Majority of the apps are reviewed based on price, the positives and negatives of the app, and its usefulness to both patients and medical experts. It also has a rating section for user interface, multimedia usage, and real world applicability. The one drawback is that the apps are not reviewed by patients themselves, which could bolster the reviews.

Sample of’s review of the “Kids Beating Asthma” app.

Read the rest of this entry → : healthcare prices in full view for facilities nationwide

April 10, 2013 in health care costs, Hospital Bills, Insurance Bills, Member Stories

Pricing Healthcare is blowing the doors off of healthcare pricing by exposing the closely guarded pricing secrets of insurers and healthcare providers – nationwide.

When we release our free Beta in June 2013 (, we won’t be just another site providing over-generalized estimates or very small fragments of the pricing picture for medical services.  We let consumers go to a single, easy-to-use website where they can compare actual procedure-level prices across all the healthcare facilities in their area.  There are a lot of prices out there: providers’ list prices, insurance-negotiated rates, and the “black market” price – discounted rates for cash payers not claiming insurance.  We show people all of it.  You wouldn’t believe how varied they can be, and you might find that paying cash is considerably cheaper than going through your insurance.  This doesn’t exist anywhere else, and it has the potential to save a lot of people in America hundreds and thousands of dollars in medical costs.

Other companies have tried to get ahold of pricing information from hospitals and insurers for years, but it’s in the best interests of the medical establishment to keep their prices from patients.  Open pricing leads to competition, when tends to lower prices.  The only people who benefit from this is consumers (exactly!).

The data that could transform the healthcare industry is out there.  It’s sitting in our file cabinets and in the pile of bills on our kitchen counter. Our model is to help patients come together at the grass roots level, and anonymously share the pricing data from their healthcare bills online.  That data is then combined and shown for your specific community, anywhere in the country.  It’s as simple as it is revolutionary.

Imagine what we could all do, collectively, with all the data from our healthcare bills anonymously online and freely available to other consumers.  Healthcare providers, like all American businesses, will have to compete on quality and price.

We are running a crowd-funding campaign to let consumers participate early and help ensure the revolution is a reality.  You can learn more about us at

A Picture of Health in America

April 8, 2013 in Member Stories

Health in America
Source: Best Masters in Healthcare

As one of the largest segements of the US economy, health care accounts for trillions of dollars in spending, both by governments and private individuals. At Top Masters in Healthcare, we decided to take a closer look at where the money goes in this infographic titled A Picture of Health.

The impact of the healthcare industry on everyday Americans continues to grow, whether they see it in their insurance bill or whether they earn their salaries from the health care industry. The issue also continues to dominate the political conversation… there’s no escaping it.

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 →

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?