Quit Wasting My Healthcare

Universal Coverage Today

August 24, 2009 – 7:30 am by ScottSchoenvogel

Occasionally you will see a healthcare expert try to make the point that universal healthcare coverage exists today. While the reality is more complicated than the statement, there is truth in the fact that life-saving care is almost always available in today's US healthcare system. When a healthcare consumer is faced with a medical emergency, it can be important to understand how the system works. There are major laws, state by state non-profit tax regulations, and numerous government support programs that make care available to those who find themselves in a difficult financial situation. The primary law is EMTALA and basically states that a hospital can not turn an emergent patient away before he or she is stabilized. If you looked at tax regulations in Texas, a not-for-profit healthcare system has to provide at least 4% of its net revenue in some form of charity or financial assistance to keep its non-profit (non-taxable) ...

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Preventive Medicine: Cost Savings Under Attack

August 19, 2009 – 7:10 am by ScottSchoenvogel

I have been surprised to see the dramatic increase in articles questioning the cost saving power of preventive medicine. See the latest article from the NY Times: http://prescriptions.blogs.nytimes.com/2009/08/18/the-problem-with-prevention/ While I am not qualified to question or evaluate the validity of the points in the article, the round of questioning by many recognized experts is simply enough to emphasize the need for other ways to control costs. That is why being in control as a savvy healthcare consumer is so key to both short and long term cost management strategies.

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Outpatient vs. Inpatient

August 18, 2009 – 8:32 am by ScottSchoenvogel

Many consumers automatically think that outpatient surgery is more cost-effective than inpatient surgery. While the outcomes are generally the same and patient convenience may increase with outpatient surgery, inpatient stays are often more cost effective by a factor of 5X! The reason is that outpatient surgical reimbursements often uses an old reimbursement model that pays a relatively high percentage of charges while inpatient reimbursement is often based on a low daily fixed rate called a "per diem". The charges do not vary much between settings because most of the charge is driven by the operating room experience and not the overnight stay. If the charges are both high and nearly the same, a consumer would want to protect themselves against the high charge by choosing the low fixed rate. At the end of the day, it is up to the doctor whether you qualify for an outpatient surgery. Even if you do, you ...

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Over-Utilization of MRIs

August 17, 2009 – 7:46 am by ScottSchoenvogel

Time had a good article this week on the clinical necessity of an MRI to diagnose breast cancer. http://www.time.com/time/health/article/0,8599,1916045,00.html I liked the article because it pointed out that our culture of "more information is better" is not always true and can lead to unnecessary services when lower cost treatments could have had the same or better outcome. I think it also emphasizes a philosophy where a patient builds up to to the most invasive treatments instead of immediately jumping to that treatment on the basis of what is technically inconclusive data. We are starting to see this philosophy more and more in the consumers we help. "Let me try medicines. If that doesn't work, then I will try non-invasive treatment and low intensity surgery. Finally, I will have the major procedure if nothing else works." The important point is that treatment is immediately commenced and the opportunity for success in both medicines and non-invasive treatments ...

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Hospital Support for Reform

August 12, 2009 – 9:59 am by ScottSchoenvogel

Kaiser had a good interview with Chip Kahn, the president of a major for-profit U.S. hospital federation. http://www.kaiserhealthnews.org/Checking-In-With/Checking-in-Chip-Kahn.aspx Chip has balanced comments even about the possible success (or lack there of) of a Mayo type healthcare model. It is clear from Chip's point of view that hospitals support reform as long as they don't get stuck with Medicare rates that fail to cover hospital costs and that access to care / insurance improves for millions of Americans. When access to care / insurance improves, hospital volumes and reimbursements increase. The problem is that this dynamic does not necessarily lend itself to "bending the cost curve". Clearly, more access to care with better insurance for a population that is an underutilizer of care right now will lead to increased national healthcare expenditure. Over the long term, better care should divert more intensive procedures / costs but as we discussed in a different blog the net ...

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Pediatric Consumerism

August 10, 2009 – 8:50 am by ScottSchoenvogel

I had first hand experience this weekend using a significant amount of healthcare service for the lowest cost possible. Here is the short story: my two year old daughter had a fever and started coughing in her sleep Friday night. We use a pediatrician that is open on Saturday so we walk in for a simple pediatrician visit at 9 am on Saturday morning. The diagnosis is ear infection. We are prescribed some generic antibiotics and get a free sample of cough medication. After feeling great all day on Saturday, my daughter is then up all night coughing, weezing, writhing, and crying hoarsely. Turns out that she really has the croup (basically, a dangerous form of laryngitis for kids). We are able to call the pediatrician's nurse hotline on Sunday morning and figure out that steroids are recommended for cases where wheezing and throat inflammation continue (swollen throats in children can ...

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The Co-Op Model

August 6, 2009 – 8:43 am by ScottSchoenvogel

One of the solutions being battered about in the news regarding the various health reform proposals is the use of an insurance co-op model vs. a public option insurance plan. A co-op is just a legal structure for a bunch of individuals and families to buy insurance as if they were an employer. At one point, Compass thought this would be a great structure to combine with our consumer support tools and knowledge regarding cost effective plan designs. When we did more research on the model, we found that existing co-ops often struggled because many people joined the group who could not get insurance otherwise. When the claims of those high healthcare users began to impact renewal rates, premiums for the overall group began to go up forcing out members who could get low cost individually rated private insurance. This left the co-op in a downward spiral of costs which is ...

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Surgical Physician Assistants

August 5, 2009 – 7:34 am by ScottSchoenvogel

We are seeing an increasing amount of billing abuse from surgical physician assistants who are balance billing patients the same gross charge as the physician - a cost usually between $5,000 and $10,000. The reality is that most insurance companies only allow these physician assistant to bill a quarter of the physician fee - often 5% or less of the total charge. Consumers should be on the alert for this type of bad billing practice.

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Surgical Volume Anecdotes – Behavior is Changing

August 5, 2009 – 7:31 am by ScottSchoenvogel

Eric told me last night that the surgical volume in many of the surrounding hospitals seem to be down substantially. When talking to GI docs about their endoscopies, Eric noted that they were complaining that volumes for diagnostic endoscopies had dropped from 10 a week to 2 per doctor. When the doctor described what was happening, many patients were simply saying "Doc, can I just try the medicine first" and the doc has to say "sure". The point is that high deductible health plans and the economy are pushing people away from expensive procedures because those hit procedures are starting to hit patient pocket books in a way that matters. This trend just emphasizes the point that the path to behavior change is through the pocketbook and the responsible way to manage that change is by teaching people to become good healthcare consumers.

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Great WSJ Opinion Article on Health Reform

August 5, 2009 – 7:26 am by ScottSchoenvogel

http://online.wsj.com/article/SB10001424052970204619004574324361508092006.html Mr. Laffer simply points out that any plan that does tie patients to their healthcare costs will ultimately create unfettered demand and promote runaway costs. Nothing in the healthcare reform lexicon today seems to focus on this fact and thus reform discussions as they exist will only further the existing cost problem.

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Quit Wasting My Healthcare

Universal Coverage Today

Preventive Medicine: Cost Savings Under Attack

Outpatient vs. Inpatient

Over-Utilization of MRIs

Hospital Support for Reform

Pediatric Consumerism

The Co-Op Model

Surgical Physician Assistants

Surgical Volume Anecdotes – Behavior is Changing

Great WSJ Opinion Article on Health Reform

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