Quit Wasting My Healthcare

Consumers as ‘Stewards’ to Address 4 Issues that Stymie Health Reform

June 30, 2009 – 3:18 pm by DrEric
The Associated Press reported today that there are 4 issues that "could dash President Barack Obama's hopes for overhauling healthcare." (http://www.boston.com/news/nation/washington/articles/2009/06/30/hard_choices_on_4_big_issues_stymie_health_push/?rss_id=Boston.com+--+Latest+news) Issue #1 - Cost - $1 - $2 Trillion over the next 10 years Consumers as 'Stewards' can lower cost by including cost in the healthcare decision making process. The doctor in the exam room and their patient must talk about cost. If a doctor and patient view healthcare as spending someone else's money, costs will never be controlled. Incentives must be aligned so that as good stewards of health and healthcare resources, physicians can offer and consumers can receive equal--and often better--care at a lower cost. Issue #2 - Employer Mandate Consumers as 'Stewards' can reduce the need for an employer mandate by purchasing insurance on the open market. For employees who currently work for companies that do not offer health insurance, there is an option to purchase ...

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Overutilization Again Identified as Cause of High Healthcare Costs

June 5, 2009 – 3:07 pm by DrEric
The recent article in the New Yorker entitled "The Cost Conundrum--What a Texas town can teach us about health care" is very good: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=1 Atul Gawande has laid out the underlying cause of high healthcare costs: Overutilization. In my opinion, he has hit the nail on the head. I want to make as few comments as possible so that the article can stand on its own, but I can say that addressing overutilization at the patient-physician relationship level is the best way to improve quality and decrease cost at the same time. Physicians respond best to their patients. Having the government, insurance companies or large employers dictate practice patterns and treatment recommendations will generate tremendous push-back from physicians. No matter how well "proven" or well intentioned those recommendations, the shear fact of who they are coming from will discredit them by physicians. One can say that is not right, ...

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The #1 Thing You Can Do to Impove Healthcare Quality

May 14, 2009 – 3:49 pm by DrEric
On this blog I write a lot about how to be more cost-effective in providing and receiving care. So today I am going to focus on QUALITY. Much is in the TV news, magazines and professional journals about physician and healthcare quality. Usually the story is that quality is BAD... terrrible in fact. I am not going to tell you if your doctor is good or bad, but there is one thing YOU CAN DO to improve the quality of care that YOU receive PERSONALLY that does not require an act of Congress, a complicated health website or an episode of Oprah. The #1 thing you can do is: TAKE NOTES Take notes during your doctor visit. Take notes when you are in the ER. Take notes if you are in the hospital. Always have a pen and paper in hand. If because of your medical ...

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Comparative-Effectiveness Studies, Obama and High-Quality Care Now

May 5, 2009 – 3:47 pm by DrEric
In the Sunday Magazine section of the New York Times this past weekend (http://www.nytimes.com/2009/05/03/magazine/03Obama-t.html?_r=1&scp=1&sq=after%20the%20great%20recession&st=cse) there is an interview with President Obama on a range of subjects including healthcare. In the article, Mr. Obama says, "So when Peter Orszag and I talk about the importance of using comparative-effectiveness studies as a way of reining in costs, that's not an attempt to micromanage the doctor-patient relationship." My argument to this point is that rather than sponsoring comparative-effectiveness studies, there are quite a few medical situations where there is a combination of scientific evidence and expert concensus by physician societies on more cost-effective ways of delivering quality care. BUT, those cost-effect, high-quality ways are NOT IMPLEMENTED. The greatest short-term opportunity lies in the effective implementation of the existing best-practices. The old proverb says, "To know and not do is to not know." As an example, a very large cost-component for employers ...

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How to Talk to Your Doctor about Cost–Tests & Procedures

April 15, 2009 – 8:01 am by DrEric
People often ask me, "How do I bring up cost with my doctor? I want the best for my health and the doctor just seems so busy. I don't want to bother him." Here is what I tell people to say to their doctor: "This test could end up costing me hundreds of dollars. I'd like to check with my patient advocate first to compare some prices in the area. Can this test wait a day or two?" Let's run through these three sentences one-by-one: 1. "This test could end up costing me hundreds of dollars." The doctor has no idea what the test will cost you. The doctor has no idea what the terms of your insurance are, what your deductible is, what your coinsurance is and what your out-of-pocket maximum is. All of her patients have different insurance policies, so it is impossible for ...

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How to Talk to Your Doctor about Cost–Medications

March 24, 2009 – 2:50 pm by DrEric
This topic of "how to talk to your doctor about cost" has been addressed previuosly in this blog, but I want to bring it up again because it is a true culture change... and culture change is tough. For medications: When the doctor writes you a prescription, often he or she will write it out and not even tell you the name, how often to take it or what it does. So the First Question needs to be: "What is this?" Second Question: "Is this a brand name or generic medication?" If the medication is NOT generic, the Third Question is: "Is there a generic medication that treats the same thing that this brand name medication treats and why can't I take the generic?" Write that down on a sheet of paper and take it to your doctor: "Is there a generic medication that treats the same thing that ...

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Healthcare Innovation and the New York Times

March 3, 2009 – 1:50 pm by DrEric
This past Sunday, the New York Times Business Section featured an article on large health insurance plans (http://www.nytimes.com/2009/03/01/business/01health.html?_r=1&scp=1&sq=aetna,%20healthcare&st=cse).   The most intriguing point for me was the quote by Paul Grundy, MD from IBM who said that insurers “don’t have a clue about providing what we really want to buy.”  The article goes on to report that “insurers say they are innovating.”   But how can there be such a disconnect between insurers and their large employer customers?  I think the answer lies in the varying priorities and demands of employer clients themselves.  Through my discussion with dozens of employers big and small, I am struck by how they all “want” the same thing—better healthcare for less money.   However, they all have their own ideas on “how to get” what they “want.”  Some believe wellness is the answer—keep people from getting sick in the first place through improved personal habits with the big three being ...

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Coordinating Consumerism with Wellness

February 20, 2009 – 1:27 pm by DrEric
Many benefits consultants and human resources representatives I have spoken with are very focused on wellness programs as their main strategy for employee healthcare cost-containment.  They want to not just lower their medical spend this year, but they also want the slow the rate of increase in the future.   Let me repeat this goal:  They want to not just lower their medical spend this year, but they also want to slow the rate of increase in the future.   They believe that by keeping their employees and their dependents healthy they can decrease healthcare service utilization and lower claim costs.   This leaves some unanswered questions for those who have invested in wellness, but have not seen their claim costs go down.  Some employees are still going to have medical problems and others are going to have chronic diseases.  If the number of employees using healthcare services decreases due to the success of a wellness ...

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5 Ways to Manage Pediatrician Costs

February 9, 2009 – 6:43 am by ScottSchoenvogel
Recently, Compass has been helping more and more families manage the costs incurred when going to the pediatrician.  Keep in mind that the average pediatrician charges just over $100 for a single visit for which the pediatrician is paid $70 by the typical insurance company. Here are the tricks that tend to make the most difference in cost: 1. Select a pediatrician who performs labs and x-rays in office.  Those who don't often send patients to an independent lab or hospital for these tests which typically receive much higher payments from the insurance company.  Also, many benefit plans will simply apply in office labs and x-rays to your office visit co-pay costing you much, much less. 2. Find a pediatrician group with a 24 hour nurse hotline.  Our pediatrician has one that costs $12 per call.  Each time my wife is concerned about our daughter and uses the hotline, we frequently are told what to do ...

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Obama’s Healthcare Plan

January 4, 2009 – 8:03 pm by ScottSchoenvogel
I get asked almost every other day what I think about Obama's healthcare plan.  You can read it yourself by following this link - http://www.barackobama.com/pdf/HealthPlanOverview.pdf. The most I can say about this plan is that it sounds nice.  I want there to be better healthcare technology and affordable health insurance.  It would also make our jobs at Compass easier if hospitals had to disclose true costs and meaningful quality metrics.  Unfortunately, these are all just platitudes and there are no plan specifics as to how these goals would be accomplished or funded. The reality is that new healthcare technology is overwhelming complex, expensive, and difficult to implement.  Revealing true costs to consumers would be nice if there weren't confidentiality agreements in place legally preventing costs from being shared.  Healthcare has only become more fragmented as physicians have continued to sub-specialize and open their own surgery centers.  To compete, hospitals have focused on patient experience and service thereby ...

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