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Patients Exposing Medical Prices, Taking Matters Into Their Own Hands

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

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

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

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

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

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

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

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 (www.nytimes.com)

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 →

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 (www.life2heal.files.wordpress.com)

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 (www.disabledlifemedia.com)

You, your employer and your health

March 19, 2013 in health care costs, Health Insurance, News

Is your employer offering rewards or penalties if you participate in a wellness program, stop smoking or lose weight?

photo credit (www.pgcompanies.com)

CVS is joining a growing list of employers who tie wellness participation to rewards and penalties. In this case, the pharmacy chain says employees can save $50 a month on their insurance if they have a series of tests (body mass index, blood pressure, etc.).  Employees who don’t have the tests lose the money, $600 a year.

CVS Caremark spokesman Michael D’Angelis told the Boston Herald that the policy will help “colleagues take more responsibility for improving their health and managing health-associated costs.” The company says a third party will review and manage the employees’ test results. Some privacy advocates worry CVS and other firms will use the information to discriminate against less healthy workers who drive up health care costs.

More companies are expected to follow the example of CVS by offering incentives/penalties in exchange for monitoring employees’ health.  Affordable Care Act rules that encourage these options take effect January 1, 2014.  The Obama administration says expanding wellness programs “may offer our nation the opportunity to not only improve the health of Americans, but also help control health care spending.”

What’s happening in your workplace?

 

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How healthy is your state?

December 17, 2012 in health care costs, lifestyle, News

Vermont is no. 1, again, in the annual health ranking of states from the United Health Foundation. Here’s more from the foundation’s summary:

Hawaii is ranked second this year. New Hampshire is third, followed by Massachusetts and Minnesota. Mississippi and Louisiana tie for 49th as the least healthy states. Arkansas, West Virginia, and South Carolina complete the bottom 5 states.

My state, Massachusetts, is 4th overall, but 40th when it comes to binge drinking (is that because we have so many universities?) and we have a high rate of preventable hospitalizations (is this a case of supply driving demand?).

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.

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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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:

Medical Care Risks (C.diff in USA hospitals)

August 16, 2012 in Medical Care, News

A report in the current issue of USA today on the front page has the heading ‘One bacteria, 30,000 deaths’, with the subtitle ‘When Health Care Makes You Sick.’  The story is illustrative for two important terms.  The first is nosocomial infection, also known as hospital acquired infection.  The second is iatrogenics, which is illness caused by medical examination or treatment.  These are real problems for all of us real people..

Health professionals and hospitals do wonderful things that improve health and well-being.   I personally have had tremendous support and benefit from physicians, hospitals, medical therapies, and medicines on multiple occasions.  But dangers are always there lurking to strike the patient unexpectedly. I have been known to reject medical advice  and/or delay medical care, in my own self-interest when I believed the risks outweighed the benefits.  These are difficult decisions, but I try to take into account the risks to me..

Often, but not always, it is accepted that the patient has the right to decide for him/herself.  Sometimes the patient will make a wrong decision just as the medical system can generate bad choices.  For example, Steve Jobs is reported to have regretted delaying surgery for so long while seeking alternative therapy.  To me, the point is that no decision maker is right all the time.  But in case of doubt, who is better to make the tough decisions than the person personally taking the risks.

References:

>>>http://www.usatoday.com/news/health/story/2012-08-16/deadly-bacteria-hospital-infections/57079514/1

>>> http://www.telegraph.co.uk/technology/apple/8841347/Steve-Jobs-regretted-trying-to-beat-cancer-with-alternative-medicine-for-so-long.html

Dollars and Dentists

August 1, 2012 in dental, News

Here is the link to a report on “Dollars and Dentists.”  The report was posted by PBS at the end of June and describes an investigation by The Center for Public Integrity and Frontline on a broken dental care system.  http://www.pbs.org/wgbh/pages/frontline/dollars-and-dentists/  The video is 53 minutes long, so it’s best to look at when you have a little time.

Massachusetts 2012 Ballot

July 23, 2012 in lifestyle, News

Two of three measures on the Massachusetts statewide ballot for 2012 relate to healthcare.

One is the Medical Marijuana Initiative and the other is the Death with Dignity initiative.  http://ballotpedia.org/wiki/index.php/Massachusetts_2012_ballot_measures

On the face of it, I favor both for the reason of allowing people to control their own destinies when possible and when others are not being harmed.  In other words, In these cases, I support the Platinum Rule over the Golden Rule.  (For comparison, see http://en.wikipedia.org/wiki/Golden_Rule or search online for Platinum Rule.)

Next of kin entitlement

July 13, 2012 in News

This story is indicative of the variety of issues that can arise relating to hospital care.  According to the news report, a woman in Texas is struggling to retrieve her husband’s heart from a hospital seven years after a clinical autopsy was done.  The hospital had earlier lost a claim for negligence in handling of the autopsy, and is appealing the $2 million fraud award to the woman.  http://www.propublica.org/article/cardiac-arrest-hospital-refuses-to-give-widow-her-husbands-heart

Medical Claim Error Rates Decline According to Latest Report Card

June 24, 2012 in health care costs, Health Insurance, News

News from the medical industry shows that the American Medical Association or AMA is working with private health insurers to lower the rates of medical billing errors within the American healthcare system. For a while now, the AMA has been talking about a collaborative effort to make medical billing more efficient, and it seems that this initiative is starting to pay off, according to this year’s National Health Insurers Report Card, an annual report released by the AMA to document national trends.

Overall Error Rates for Medical Claims

The new report shows inaccuracies for private health insurer payments dropping from nearly 20% in 2011 to just under 10% in 2012. The AMA claims that this 50% reduction has saved the industry over $8 billion, and that there’s a lot more potential for improvement. In a press release this month, AMA Board Chairman Robert M. Wah is quoted as saying that first-time accuracy in medical claim payments “saves precious healthcare dollars and frees physicians from needless administrative tasks” – that’s the idea behind these sorts of efforts to increase accuracy. These improvements help physician offices manage revenue cycles, while they also help you to understand your financial responsibility and contribute to greater transparency in the healthcare market.

Other Numbers

The National Health Insurer Report Card also provide some other assessments of this year’s trends within the medical industry. While the report shows improved response times for medical claim payments, and indicates greater transparency by health insurance companies, it also shows that medical claim denials are now on the rise. The AMA sites a prior decline between 2008 and 2011 that was reversed this year with an increase of nearly 70%. This increase, according to the AMA report, was across the board, as all major insurers declined many more claims than they had the previous year. Denials will be an issue that third party medical advocates and others will continue to evaluate in order to make sure that you are getting a fair shake when it comes to your healthcare costs.

We face a lot of challenges in identifying and controlling our health care costs. Keep informed on what’s happening in the health care industry as it affects you.

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Negative Emotions – Anger, Anxiety and Minor Depression

June 20, 2012 in News

Happiness, affection, excitement – these and other pleasant emotions make life seem wonderful. Everyone wants his or her life to be filled with such good feelings. But people’s lives are not filled with positive emotions all the time. Many events in life are stressful and produce unpleasant, negative feelings. Such emotions can be triggered by a wide variety of events. The negative feelings that result can disrupt the emotional well-being of everyone.

An important part of emotional health involves learning to cope with negative emotions. Coping represents an attempt to remove or resolve a stressful situation or insulate oneself from the negative emotions that it can cause.

Negative feelings may result directly from unhappy situations such as fear of harm and sadness of loss. Your life includes situations which give rise to such emotions, and they must generally be accepted and lived through. If you are able to cope with a situation successfully, you will return to a normal state of emotional health.
Read the rest of this entry →

Empowering healthcare consumers: FAIR Health online tools shed light on healthcare costs

March 16, 2012 in health care costs, Health Insurance, Insurance Bills, Member Stories, News

By Robin Gelburd

Recent survey reports have shown that current economic uncertainty and continued unemployment are compelling millions of Americans to delay or forgo medical and dental treatments.

Consumers concerned about healthcare expenses should be able to find out the cost of procedures or treatments in advance of seeing a doctor – regardless of whether or not they are insured. And, if consumers are insured, they should be able to determine if their doctors are in their insurance plans’ networks.

This is where the not-for-profit organization, FAIR Health, comes in. FAIR Health was created to bring transparency to healthcare costs and out-of-network reimbursement. FAIR Health created a free tool that gives consumers access to estimated costs of medical and dental treatments based on insurance status, level of insurance, and geographic area.

How does FAIR Health do this? FAIR Health maintains a database with records for more than 13 billion de-identified, private healthcare procedures from the last ten years. The database reflects the healthcare claims experience of more than 125 million people covered be private health insurance, making it the largest such data resource in the nation that is owned and overseen by an independent, third-party organization. Read the rest of this entry →

A Patient Perspective on the New Health Records Regulations

February 28, 2012 in health care costs, Member Stories, News

The federal government has been busy trying to get doctors and hospitals to use electronic health records (EHR) and to make appropriate access to the records easier. They do this by issuing regulations for EHRs linked to tens of $Billions in incentives. Stage 1 of this effort began a few years ago and has had almost no visible effect on care coordination and patient access to records. Stage 2 is about to turn up the heat. If things stay on track, by the beginning of 2014 patients will have vastly increased access to their own information and will have a secure email system to communicate with their doctors.

HHS released the proposed Meaningful Use Stage 2 regulations last week. I’ve abstracted the 455 page document to less than 4 pages of items that directly impact patients.  My preliminary conclusion is that Stage 2 is a huge leap toward coordinated, patient-centered care and makes unprecedented efforts toward patient engagement.

By mandating comprehensive structured summaries be available to patients for download as well as on-line viewing, Stage 2 enables patient-directed health information exchange as an alternative to hidden provider-provider transactions that characterized earlier HIE efforts.

Although not mentioned by name, the implied use of Direct secure messaging for physician-physician and patient-physician communications will hopefully finally cause all EHRs to communicate with all other EHRs and PHRs without costly interfaces.

Also, new requirements for accessible imaging should eliminate the hassle of CDs for patients and doctors alike and make referrals and second opinions easier than ever.

All of these privacy, transparency and accessibility enhancements come none-too-soon as ACO payment reforms implicitly drive providers to keep patients in their particular network. Effective patient access to both cost and medical data is essential to preserving informed choice, reducing fraud and enabling the independent assessment of quality.

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Defense Mechanisms to Cope with Painful Emotions

February 17, 2012 in News

Finding ways to cope with painful emotions can be one of the most critical ongoing efforts of your life. Change is an inevitable part of the human life: a family breaks up, a child leaves home, a mother or wife returns to work, you find a new job or go to new school. You are forced to adapt to all these changes. Luckily, your mind and body are adaptable. You may work through such adaptations by using your defense mechanisms- mental strategies to for preserving yourself from anxiety, stress or depression.

Defense mechanisms can lead to problems if they become your primary or only way of dealing with such problems. However, they can also be used to help you to adjust to stressful situations. Check out the common defense mechanisms, understand them and use them when you need. Read the rest of this entry →

Prescription drug coverage: the high cost of choice

January 16, 2012 in Health Insurance, Member Stories, News

The recent news about the change in Express Scripts coverage in Massachusetts has led me to think about my own prescription drug coverage. While I still technically have the freedom to choose a pharmacy, the coverage from my provider basically locks me in to its own pharmacy chain (CVS) or else I incur significant out-of-pocket costs. For someone who likes to support local, independent business (including my local pharmacy), this has caused me much angst.

My son has been taking the antiepileptical drug Keppra to manage his epilepsy since 2008. At the beginning, I refilled his prescription monthly: my employer-provided prescription drug insurance (CVS/Caremark) which covered 80% of the cost, and I was responsible for the remaining 20% (approximately $100/month). This was the case no matter which in-network pharmacy I selected (and I preferred to go to a local pharmacy that not only knew me and my family, but also offered more services than the chain stores nearby). In 2011, my coverage changed, particularly with respect to maintenance medications, like the Keppra my son takes. The changes offered savings to those who selected mail order or 90 day supplies of their maintenance medications. The catch? The prescription gets filled by a CVS pharmacy.  If I continued to refill the prescription monthly, at our independent store, I would be responsible for 20% of the drug cost for the first two months and then 50% of the cost for the remainder of the year (approximately $1,750/year). Switching to CVS costs me approximately $650/year, a significant savings, but not without its additional “costs.” The service at CVS is terrible: pharmacists have made labeling/medication instruction errors that I have to tell them to correct, and on three occasions, the pharmacy hasn’t had the full amount of the medication at the time the prescription should be ready. This is unacceptable for a drug I order every 90 days. Should my son go without even one dose of this medication, he can begin having seizures. Unfortunately, the significant cost difference — $1,100/year, nothing to sneeze at! — has me locked in to a subpar option and doesn’t allow me to shop at my preferred pharmacy. I want to be thankful to have an opportunity to save money, but instead, as a consumer, this makes me angry. Am I alone?

Shopping For A Doctor Vs. A Dishwasher

December 14, 2011 in News

This is a perfect illustration of Healthcare Savvy’s reason for being: The Washington Post’s great WonkBlog writes here about how much effort people devote to shopping for a doctor vs. an appliance. You guessed it, the appliances win, hands down. But of course, it’s not for lack of interest or desire on the part of the health care consumers — it’s because we just don’t have as much data on doctors as dishwashers, for all sorts of reasons…Sarah Kliff writes:

This is surprising in the context of what a big chunk of consumer budgets go toward health care: The average family with employer-sponsored insurance spends $10,944 on premiums each year. But it’s perhaps explained by one of the survey’s other findings. Americans might not shop for health care because they have little confidence in their ability to do so. Shopping for a doctor is a lot harder than shopping for a dishwasher. There’s no price tag for what you’ll pay, or a Consumer Report to reference on quality. That might be one reason that Americans spend relatively little time thinking about their health-care spending choices: They don’t believe they’ll make a better choice for the cost or quality of care they receive.

Excellent comments follow, including:

“Doctors complain that a patient’s unique circumstances make it impossible to judge the patient outcome based on something the doctor did (or didn’t) do. I haven’t yet heard of an effort by physicians to help implement a ratings system that would be fair to both the patients and the doctors. There are a lot of stories about doctors fighting tooth and nail to keep such ratings systems down …

Even Angie’s List who claims to have physician reviews have remarkably few reviews. I’m not sure how you give patients anonymity (to assure honest opinions) while protecting them from a backlash from the physician and protecting doctors from people with an axe to grind.

I don’t have an answer for this problem, but doctors feeling like no one has the right to judge them is the first problem that will have to be dealt with.”

Is Medicare Public or Private Insurance?

December 5, 2011 in Health Insurance, Medicare, News

Among seniors and those about to sign up for Medicare, some of the most confusing statements in the Medicare budget debate in Congress and on the “airwaves” involve the use of the terms “private” and “public option” to describe the various “Parts” of Medicare

But the easy answer to the headline question, if you are confused by the public vs. private statements, is “It’s a trick question.” (Or if you are an old Saturday Night Live fan, the answer is “It’s both floor wax and desert topping.”)

The words “private” and “public option” have no particular meaning to the Medicare beneficiary. In fact, all Parts of Medicare — A, B, C and D — are public in the sense that they are run by the United States government’s Centers of Medicare and Medicaid Services (CMS). And they are private in the sense that the CMS uses private insurance companies to run them. 

But if you want more detail on the private/public Medicare name game, read on. Read the rest of this entry →