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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?

Here’s one reason you can’t find health care prices…

March 18, 2013 in Health Insurance, Hospital Bills, Member Stories

Most states don’t have laws requiring hospitals and other providers to tell you how much anything costs.

That’s the finding of a report that gives 29 states an “F” for transparency in health care pricing and nine a “D.” As Kaiser Health News reports, a group that includes some of the country’s largest employers plans to issue annual report cards on transparency.

Massachusetts and New Hampshire are the only two states (in blue) that get “A”s. The provision of the Massachusetts law that says insurers and providers will have to give you a price for an MRI, if you call, takes effect later this year. I’ve tried to find out how much hospitals and labs in the Bay State charge for services; it’s very difficult.  So for now, the “A” awarded to Massachusetts must be for intent, not action.

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by HCSavvy

Searching for a Nursing Home?

March 14, 2013 in health care costs, Medicare, Member Stories

Our parents and grandparents often drain the last of their savings to pay a nursing home bill. So it makes sense to shop around, both for cost and quality. UPI has a story about this site which looks like a good place to start if you want to compare options for a friend or loved one.

The site does not show ANY nursing homes in Massachusetts with a five star rating. There are nine with four stars. In Boston, the average daily charge is $323.70 and the avg. quality rating is 2.9 stars. That’s a lot of money for average quality.

Say goodbye to annual Pap smears

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

(photo credit, www.girlslife.com)

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 →

Please Medicare, you can do better than this

March 5, 2013 in health care costs, Hospital Bills, Member Stories

I wrote to Medicare a while back, asking for a price. I know nothing is simple in the world of health care costs, but I just needed one number, a number Medicare uses, I assume, to calculate payments to doctors and hospitals all the time.

Here’s what I wanted to know: how much does Medicare pay a particular hospital in Boston for a colonoscopy (it was for a story I wrote about searching for the best colonoscopy in our medical Mecca).

The first response I got, at a time when we’re supposed to have more price transparency, was ridiculous. If I can figure this out, I should be awarded an honorary masters in something, don’t you think?

For the inpatient hospital side:

If you want to calculate a hospital specific DRG payment for a specific fiscal year, look at that year’s IPPS Impact file to get the hospital’s wage index.

Then you can look at Table 5 for the FY 2009 Final Rule to get the relative weights for the MS-DRGs you are interested in. Finally, you can determine the FY 2009 labor related share and non-labor related share rates from Table 1A in the FY 2009 Final Rule.

These files and tables can be found here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Acute-Inpatient-Files-for-Download-Items/CMS1247872.html

Then the hospital specific DRG payment can be calculated as follows: (wage index x labor related share + non-labor related share) x DRG relative weight.

For the outpatient side:

Medicare Part B data by procedure code for specific years are posted: http://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/NonIdentifiableDataFiles/PartBNationalSummaryDataFile.html Data are presented by 5-digit code so you would need to know the code for CT scan and MRI. Code range categories are identified in the readme file which is included in the zipped file.

A colonoscopy for the inpatient side does not affect the MS-DRG assignment. You will only be able to narrow it down by looking at the procedure codes. Below are the two most common reported.

ICD-9-CM procedure code 45.23, Colonoscopy

ICD-9-CM procedure code 45.25, Closed [endoscopic] biopsy of large intestine – this code includes colonoscopy with biopsy

So I write back to Medicare. Really, I ask, is this what I have to do to find out how much you pay a hospital for a basic test? Read the rest of this entry →

Gum, popsicles, Meow Mix, what’s “food” in your state?

February 28, 2013 in Member Stories, nutrition

My state, Massachusetts is debating whether soda and candy are food and should continue to be exempt from the state sales tax.  That made me wonder…what do other states put in the category, “food”?

The always helpful folks at the National Conference of State Legislatures sent me this breakdown. Turns out there’s a lot of variety.

Gum is a food in Colorado but not in California.

Which looks more like food? Gum or… (photo credit, AP)

In D.C., Puppy Chow and other pet foods aren’t subject to the state sales tax,  but pet owners in Arizona pay it.

ice cream? (photo credit/AP)

Florida taxes ice cream and popsicles. Massachusetts does not.

Some states tax prepared food (your pre-made Caesar salad and such) some don’t.  Most take-out food that is hot is taxed.  The rules about taxing prepared cold food varies and are, in a few cases, elaborate:  Here’s Indiana…”food sold without eating utensils provided by the seller” that include “two or more food ingredients combined by the seller for sale as a single item….”  How does Indiana enforce this rule?

Very few states consider vitamins food, or the seeds used to grow vegetables, 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 →

Informed Patient Institute

February 25, 2013 in Member Stories

Hi all. I’m a recent addition to this group, but I’ve been working in and around health care from a consumer/patient/family perspective for some time.  I run a Maryland-based non profit called the Informed Patient Institute (or IPI). We provide credible access to online information about health care quality and patient safety.   We work in two areas – health care report cards and tip sheets about “what to do if you have a concern about quality.” We have a database of hundreds of doctor, hospital and nursing home report cards nationwide.  We grade them “A” thru “F” and tell you what we like about them and what could be improved.  In the tip sheet area, we’ve written plain language information about what to do if you have a concern about quality in a doctor’s office, hospital or nursing home.  In MA, because of the good work of  Health Care for All,  we link to their information about hospital quality concerns.  In the future we’d like to do work in the state on quality concerns in doctor’s offices or nursing homes.  We have this information now in CA, ME, NY and PA.  Check us out!

Empowering Healthcare Consumers

January 29, 2013 in Member Stories

By Undersecretary of Consumer Affairs Barbara Anthony

Until now, if consumers asked their doctors or hospitals how much a particular service will cost, they would be told that the price depends on their insurance plan. When consumers asked their insurance carriers the same question, they would be told that price of a health care service depends on each provider’s contract.

Thanks to Massachusetts’ recent health care quality and cost containment law, that’s about to change. Insurance companies must now develop toll-free numbers and websites through which consumers can determine the prices of provider services. Most notably, the law requires carriers to tailor the information presented to the insured’s plan, taking into account plan-specific information such as co-pay, deductible, and co-insurance.

To their credit, major Massachusetts insurers are already preparing to roll out these consumer information tools—see my January 8th op-ed  and Rob Weisman’s excellent reporting in this past Sunday’s Boston Globe. This is a great example of what industry can do to lead the way through innovation and technology that benefits competition and consumers.

We have seen an appetite on the part of insurers to get this information out there and a hunger for consumers to have it in an easily digestible way. For this reason – my office will be launching a Health Care Consumer Empowerment campaign to bring together carriers, providers, non-profits, employers, and consumers to put consumers in charge of the way they shop for health care services.

Health care consumers, like consumers in other markets, should be able to shop around and compare services including price and quality. We cannot reign in health care costs if consumers are kept in the dark about the price of health care services.

Empowering consumers with pricing information is a necessary first step toward a patient centered culture that can result in the more efficient delivery of lower cost, high quality health care services. Armed with price, consumers can continue to consider quality, location, and other factors when selecting health care services.

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An anxious month for social workers, psychologists and psychiatrists

January 28, 2013 in Insurance Bills, Member Stories, mental health

If you visit your therapist this month or next and he or she seems stressed out, it could be about money. Here’s why.

Therapists who accept health insurance submit a bill that includes a code for your visit.  90862 was, for example, a very common code for a medication adjustment visit to a psychiatrist.  As of this month, almost all the mental health codes are changing and this is causing a lot of anxiety.

Therapists aren’t sure which code to use and, they aren’t sure how much they’ll be paid.  Insurers say the new codes, which are reviewed and set by the American Medical Association, will likely mean lower reimbursement rates for therapists who don’t prescribe drugs.  Insurers say they won’t cover some of the codes at all. Many therapists are angry and discouraged.

“The Governor and the President are asking for more emphasis on mental health, but then the coding requirements increase and the reimbursements go down,” says Jonas Goldenberg with the Massachusetts chapter of the National Association of Social Workers.

Psychiatrists may see an improvement in payments for some visits because they’ll be able, for the first time, to bill for medical care they provide while monitoring the effects of medications.  But the new codes do not resolve ongoing concerns about whether mental health providers are paid at the same rate as are doctors who deal with physical health.  Under the new codes, it does not appear that psychiatrists who evaluate a patient’s physical response to medication will be paid what an internist would to make a similar evaluation.

Read the rest of this entry →

Let’s Talk Mental Health

December 20, 2012 in Member Stories, mental health

I’ve written here about migraines that sent me shopping for an MRI, my search for a “good” colonoscopy, my kids’ dental bills and a bunch of other stuff.  But I realized this week, in all the conversations after Sandy Hook, that I haven’t written anything about mental health.

My dad, Jim Bebinger, on his way to or from the Korean War, 1951

And you know what, I don’t think anyone else has either.

So let’s talk.  If a line about our anxiety or depression or phobia or addiction is as easy to throw into a conversation as a reference to our asthma, then maybe we can unravel the embarrassment or shame of living with these conditions.

Here’s a little about my experience with mental illness.  My dad killed himself when I was 17.  I lost most of my 20s to depression.  I wouldn’t be where I am without lots of therapy.  In August I started seeing a counselor again about some issues with my kids.  It’s helping a lot.

And you?  Gotta story?  Most of us do.

I look forward to reading yours.

consumer perspective – cost of inguinal hernia repair surgery – First steps.

December 18, 2012 in health care costs, Member Stories

I’ll be undergoing this procedure  later this week and reviewing costs is part of the process.

I understand that hernia surgery is routine. I called the hospital, surgeons office and insurance company. As I just summarized for a friend:

Hospital says $18,385. Surgeons office says $1450. Insurance company says don’t worry, the most you will pay is $5k.  Why is it that I feel like the mafia is running healthcare? There is truth in all those numbers. What is the truth exactly?

I expect I will get a bill like I got for my colonoscopy. Horrifying billed cost, miraculous adjustment from insurance company but still a high bottomline relative to the rest of  the country.

 

 

Keeping the Big Picture in Mind

December 16, 2012 in Member Stories

RW Johnson and Health Affairs just updated their policy brief on waste in the US health care system. It’s 5 pages short and clear and definitely worth reading.

http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=82

Adrian

Aetna offers payment estimator

December 12, 2012 in Member Stories

Here at Aetna, we read with great interest, Martha Bebinger’s story chronicling her difficulties in finding the price of an MRI at different health care facilities in her area.  As Martha notes, it is difficult for consumers to “shop around” or make “wise choices” on health care decisions when they can’t find the price of a service.

We agree, and have been working to make that price information available for the last decade. Through free member tools like our Aetna Member Payment Estimator, we provide cost information for more than 550 commonly used, non-emergency medical services, including traditional or C-section births, colonoscopies, MRIs and CT scans. Members can compare up to 10 cost estimates at a time for the selected procedure in a geographic area, so they can see cost differences among different health care providers. Better still, the Member Payment Estimator gives members a personal picture of the costs by providing real-time out-of-pocket cost estimates based on a member’s benefits plan.

Our members use this tool more than 70,000 times per month, each keeping as much as $170 in their own pockets after comparing costs on more than 30 common procedures. In 2011, the U.S. Government Accountability Office recognized the Member Payment Estimator as the only tool from a private health insurance company that “provides estimates of a consumer’s complete cost.” 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 →

Plan Ahead for International Travel Medical Bills

November 2, 2012 in health care costs, Health Insurance, Insurance Bills, lifestyle, Medical Care, Medicare, Member Stories

You may be closing out 2011 with a holiday trip, domestically or internationally. If you plan to leave the country, you may want to consider the following when it comes to your health:

  • You may not have health insurance coverage for illnesses or injuries that are treated abroad, even if you have US based medical coverage. Confirm with your benefits administrator.
  • Generally, Medicare does not provide coverage for hospital or medical costs incurred abroad, however, rare circumstances may be covered.
  • AARP can assist with obtaining foreign medical coverage and offers valuable travel tips.
  • US consulate personnel will help you locate health care providers and facilities and even contact family members, if necessary.
  • You can purchase travel insurance that covers health care needs and pays for medical evacuation if you need to be transported back to the US for treatment.

Obtaining medical treatment in another country can be expensive and a medical evacuation can cost over $50,000. Plus, you may encounter challenges with deciphering charges while abroad. Be vigilant, prepared, and follow the same self-advocacy steps you would while receiving medical care in your home state.

If you choose to purchase medical expense coverage while travelling abroad, double check you’ve carefully researched the following:

Wrong Symbol, Right Sentiment?

October 26, 2012 in Member Stories

Caduceus
(via Wikipedia)

Look at the symbol in the header for Healthcare Savvy. An emblem of medicine and healthcare, right? Yes. No. Well, sort of.

Rod of Asclepius
(via Wikipedia)

It turns out using the Caduceus, two-winged serpents entwined around a staff, as a symbol for healthcare is a case of historical mistaken identity. The official badge of medicine is the Rod of Asclepius, a single wingless snake coiled around a simple rod. Asclepius, son of Apollo, is the greek god of healing.  The cult of Asclepius– who set up healing temples around Greece– originated the Rod, and it has survived from antiquity. (It is believed that the cult allowed Aesculapian Snakes to slither freely throughout their temples to earn Asclepius’ favor.)

Ok, but why is there a Caduceus at the top of this page and not a Rod of Asclepius? Seems the misunderstanding can be traced back to 1902 when the U.S. Army Medical Corps officially adopted the Caduceus onto their badge. (Legend has it, this is entirely due to the insistence of one, slightly misinformed, officer). The Caduceus has slowly become a fixture of North American iconography ever since.

Hermes holding the Caduceus
(via Wikipedia)

 

But the plot thickens. The Caduceus stems from the greek messenger god Hermes, who carried it on his journeys. Hermes is the patron god of travelers, poets and merchants. Given the fact that healthcare in America has bloomed into BIG business (“U.S. spending annual on physicians per capita is about five times higher than peer countries“), maybe the Caduceus has  become the more appropriate symbol.  Then again, maybe it is not that simple considering Hermes is also the patron of tricksters and thieves.

What do you think? Should HealthCare Savvy be sporting the Caduceus or the Rod of Asclepius?

Billing for one medical visit

October 25, 2012 in Member Stories

I happened to be paying for trash services (one bill) at the same time as hospital medical services (two bills). One medical bill was for the doctor and the other was for the hospital.

A comparable billing arrangement on trash services would have been to receive one bill for trash collector services and another for the cost of the truck used to haul the trash.

The double billing arrangement puts distance between the medical providers and the facilities they use, and likely simplifies life for the providers, but it also separates the providers from knowledge of the true cost for medical care. Double billing also means that patients have more difficulty trying to decipher the billing.

Let’s hope that trash collectors and other service providers do not adopt a similar double billing arrangement.

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 →

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 →