March 5th, 2007 by Dr. Val Jones in News
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In this latest report from the BBC, we see that our friends across the pond are just as obsessed with appearance as we are in America. Apparently, women in their 70’s and 80’s are getting cosmetic breast surgery and face lifts.
One surgeon is quoted as saying:
“We have a growing population of pensioners – and for those who want to maintain a good appearance, ageing gracefully, the surgical options are there.”
Since when did gracefulness have anything to do with surgery?
I wonder if we’re missing the more important things in life (friendship, love, kindness, charity) by focusing on our exteriors? Beauty is a matter of the heart, I think.
Sophia Lauren once said, “Nothing makes a woman more beautiful than the belief that she is beautiful…” but then again, it looks as if she’s chosen to have extensive cosmetic work done as well.
What do you make of the growing trend in plastic surgery among seniors?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 26th, 2007 by Dr. Val Jones in Expert Interviews
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I had the chance to speak with Jim Herndon recently about how the current healthcare climate is affecting orthopedic surgeons. He said that there are 3 things that worry orthopods:
- Decreasing Medicare reimbursement. In 1990, reimbursement for a total hip procedure was $2,200. In 2007, the reimbursement is $1,190. Medicare is planning to further cut reimbursement 30% in the next 4-5 years.
- Increasing malpractice insurance costs. Premiums are steadily increasing. In Boston, the average malpractice insurance is about $50,000/year. In Philadelphia, the cost is $150,000. And if you’re an orthopedic surgeon specializing in spinal surgery, malpractice insurance premiums can start at $250,000/year.
- Pay for performance. No one really knows how this will be applied specifically to surgeons (other than the obvious infection rates), but fears are mounting regarding how to show the best possible performance in one’s practice.
Let’s say that a typical surgeon in Philadelphia pays 33% in overhead (the hospital facilities, staff, etc.). Let’s say that he is also taxed 33% on his income. That means that he’d have to perform 382 hip replacements per year, just to pay his malpractice insurance. That’s almost 2 surgeries/day, 5 days a week, 11 months/year.
So what are surgeons doing? They are reducing overhead by setting up outpatient surgery centers (Dr. Herndon estimates that 60% of orthopedic surgery can be performed in an outpatient setting), they are increasing the volume of surgeries they perform, they are buying radiology facilities where they send their patients for XRays, MRIs etc. (Dr. Herndon explains that Stark Laws don’t prohibit this, so long as the physician takes on the risk of the facility – i.e. that he can potentially make or lose money), and they are financing physical therapy practices that supply therapy to their patients.
Orthopedic surgeons in private practice have become very business savvy in order to survive in this climate. But somehow I feel saddened by all this – the business of medicine is a grim reality that can create a wedge between the physician-patient relationship. A patient is left to wonder about the motivations behind tests and therapies – and perhaps even behind recommendations for the surgery itself.
I guess the second opinion has become more important than ever before?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 14th, 2007 by Dr. Val Jones in Opinion
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One of my readers recently asked for some examples of how price transparency might improve his lot. A great question! The people who stand to benefit the most from price transparency are the uninsured and those with high deductible health savings accounts. Price transparency is globally valuable because it allows people to understand the true cost of healthcare, making them more informed consumers. It also promotes accountability of hospitals, healthcare providers, and insurance companies.
Naughty Hospitals
Arbitrary fees:
“The cost for a total hip replacement in the greater Seattle area varied between $13,996 at one local hospital and $46,758 at another. Furthermore, there wasn’t necessarily any correlation between the cost of the procedure and the hospital’s quality or experience doing it. …Why would anyone pay a higher price for lower quality and potentially more complications, especially when it concerns your health?”
Where does a non-profit put its profits? Dr. Feld knows where:
“We are unable to know the hospital’s actual overhead. If we did, we could to find out what the hospital’s actual costs are. We could then calculate the hospital’s profit. These numbers are totally opaque.
Most hospitals are non profit hospitals. They can not post a profit at the end of the year. Therefore, they have to pour the extra money into something. Executive salaries and capital expenditures are a prime avenue for getting rid of their profit. A key question is how is the hospital’s overhead calculated? Maybe reducing costs to the consumer would be a good idea?”
“Predatory hospital billing:”
Over the past year, aggressive billing practices have been exposed at a number of hospitals in the United States. Despite the fact that a widower had paid $16,000 of his late wife’s bill of $18,740, some 20 years after the incurrence of the bill a teaching hospital held a lien on his home for $40,000 in interest. Many years earlier the hospital had seized his bank account, and now the 77-year-old man was destitute. Only tremendous publicity caused the hospital to back down. In California, a patient was forced into bankruptcy in 2000 by a for-profit hospital from a day-and-a-half stay in the hospital that did not include any surgery but totaled $48,000 in hospital bills. These have become common stories as hospitals aggressively market, bill, collect, and foreclose, just like any other corporation. The uninsured are facing the brunt of the hospital industry’s billing practices.
Naughty Outpatient Facilities
“Mr. Smith needs to get an MRI. He has a high deductible HSA, with a $2000 deductible, much of which he has not yet spent. So he will likely have to pay for 100% of this service himself. Without access to cost information by facility, he would simply go to a convenient, local facility and might pay up to $1300 for this single test. If he had access to health care cost information on the web, he could look up the cost of his service across different facilities and choose to go to the one that only charges $450 – a very meaningful difference for Mr. Smith.”
“More than 3 million people have already signed up for HSAs, and 29 million are projected to do so by 2010. Forty percent of the people who bought HSAs have family incomes below $50,000. More than a third of those who bought HSAs on their own had previously been uninsured.”
Naughty Doctors
What happens when 2 procedures have been shown (through careful research) to have equal efficacy, but one is reimbursed at a much higher rate? Docs will choose to perform the more expensive one, of course.
“Prostate cancer patients’ biggest concerns — after cure — are the possible side effects of surgery, including urinary incontinence and sexual impotency. Data on these side effects from robotically assisted prostatectomy were sketchy at best, and no evidence was available to indicate that any surgical method emerged as better than another for these side effects… Open radical prostatectomy costs $487 less a case than non-robotic laparoscopy and $1,726 less than robot-assisted prostatectomy.”
Naughty Insurance Companies
Insurance companies don’t want to make their pricing public because they don’t want their competition to know how much (or how little) they’re compensating physicians. Therefore, consumers are prevented from seeing costs as well – which can hinder their ability to make informed decisions about their care.
I bet others can think of some excellent reasons why price transparency is beneficial to consumers. Care to contribute?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 26th, 2007 by Dr. Val Jones in News
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In Britain, the National Health Service used to pay for gastric bypass for individuals with BMIs greater than 35, but a new rule has raised the qualifying BMI to 45 and above. So many people were having gastric bypass, that it was overburdening the system. In response, some people are trying to gain weight to qualify for the surgery!
Here’s what a couple of British folk have to say:
“It’s grossly unfair and incredibly short-sighted. There are hundreds of other people like me who can’t afford private surgery, and the message seems to be pay up or pig out.”
“Instead of surgery and rehabilitation my only option is McDonalds and ice cream”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 17th, 2007 by Dr. Val Jones in News
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Thanks to med blogger Kevin MD for highlighting an interesting, though cynical, comment about the extended wait times that many people have in getting an appointment to see a dermatologist.
“It’s just as well that there’s a long wait. Someone who comes in with a rash is likely to be biopsied and end up with a scar. If they wait until an appointment is available the rash will probably have cleared up.”
The Boston Globe explains why consumers are having a hard time getting dermatologist appointments:
“In dermatology, the waits are created both by patient demand and, some believe, by dermatologists’ shifting their time to new, more lucrative or complex procedures. Public service campaigns have heightened fear of skin cancer, and melanoma cases are rising, meaning more people are seeking appointments.
At the same time, some dermatologists are devoting time to cosmetic procedures, or to skin cancer surgery that used to be done by general surgeons. Meanwhile, the federal government limits the number of residents hospitals can train, and hospitals would have to create more dermatology slots at the expense of other specialties. This means the number of dermatologists entering practice each year has remained flat, at about 300 nationally, making it difficult for practices to hire new doctors. Just as many have been retiring in the past five years.”
Have you had a hard time finding a dermatologist?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
