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 (www.mybackpain.info)

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 Health.com, Read the rest of this entry →

Crazy, irrational hospital billing (with no connection to quality)

May 8, 2013 in health care costs, health care quality, Hospital Bills

Try explaining this…

One hospital in my state, Massachusetts, bills Medicare $75,197 to take care of a patient with heart failure, another charges $13,960.

There’s a huge gap in the charge for patients with breathing problems who are put on a ventilator: $23,044 to $120,888.

Thanks to The Washington Post for this article with a great graphic that shows how much prices vary in each state, using data released today, by the Centers for Medicare and Medicaid Services.

Why are there huge differences in what hospitals charge?

Don’t expect a satisfying answer. 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 (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 →

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 →

Claim Modifiers: More Code-Speak on Your Medical Bills

April 26, 2013 in health care costs, Health Insurance, Hospital Bills, Insurance Bills

If you have ever been hospitalized or had a major test/procedure performed, you may have received a frustratingly hard to decipher medical bill from your provider. And, if you are insured, you will also have received a similarly cryptic Explanation of Benefits (EOB) describing your insurance company’s payment decision. (The EOBs can sometimes be a bit clearer and more detailed than the average provider bill.) To the average lay person, medical bill jargon does not sync with customer psychology in the way that other bills, like retail, residential services, etc. do. Most other industries present their bills in a careful way, focusing on clear billing, to make sure that customers know why they have financial responsibility.

CPT and Claim Modifier Codes

With that in mind, let’s look more closely at some of the usual suspects that show up on an unreadable medical bill. One type of common code is called a Current Procedural Terminology or CPT code. This code, in plain English, represents a service that a doctor (or other medical professional) provides.

CPTs often do not “read” well. Patients not involved in the medical industry themselves may have no idea what one of these codes represents on a bill. Looking at the charge associated with it can be frustrating when there’s no common-vocabulary explanation to make the patient remember just what was done in the provider office. This means that patients who are proactively concerned about their care, and costs, will often call providers or insurers just to ask “what does this CPT code mean?”

About Claim Modifiers

Claim modifiers are additional digits attached to a CPT to explain to an insurer or other party how a procedure may have differed from “the norm.” Some modifiers are also used to differentiate a core service from an advanced service level based on the doctor’s documentation. 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)

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

Read the rest of this entry →

PricingHealthcare.com : 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 (pricingHealthcare.com), 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 http://igg.me/at/pricingHealthcare.

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 (www.blogcdn.com)

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.

iPharmacy

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

http://www.cms.gov/medicare-coverage-database/details/nca-tracking-sheet.aspx?NCAId=269

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?

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Cutting Your Prescription Costs

March 20, 2013 in health care costs

Castlight Health is out with an app that lets members compare retail vs. mail order prices for prescriptions and find the closest pharmacy with the best deal. There are a growing number of places online where patients can find some health care prices, but most don’t include pharmaceuticals. More sites will likely follow suit because consumers are realizing they can save money by checking the mail order price or making a few calls to find out which local pharmacy offers the best deal.

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?

 

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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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.

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 (qualityquest.org)

One of the major elements of the act is encouraging women to visit their doctor in regards to preventive care services since, according to HealthCare.gov, 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, 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 →