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.
February 11th, 2007 by Dr. Val Jones in Opinion
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Imagine if you went to the grocery store to purchase a week’s worth of groceries – once in the store you had to select items without price tags or any labels suggesting which items were more expensive than others. In addition, all the items were behind counters, so that you had to ask for them from store personnel (and cannot inspect them at close range) who wrapped them in opaque paper and initialed them before handing them over. You were paying a monthly fee to be a store “club member” to get discounts, but were not told what those discounts might be.
So now once you’ve gathered all your groceries you stand in the check out line. The person in front of you is complaining about the outrageous price of her groceries, while the clerk responds that she didn’t force her to shop at the store or select those groceries, that it would have been cheaper if she were a club member, and that higher prices were assessed based on the individual store personnel initials that were on her paper wrapped items. The clerk also tells her that she cannot return any items (as once they’re wrapped, they’re considered non-refundable – and that she will be reported to a debt collection agency if she does not pay). The shopper is outraged, but since she doesn’t want her credit ruined, and there are no other stores within 100 miles, she pays the price and leaves.
Your turn comes to check out. You’re a club member so your bill is substantially less, but you can’t be sure what the individual items cost or which fees were added based upon the various initials written on the white paper. In fact, you have a feeling that the store staff added some additional packages to your cart when you weren’t looking, but you can’t be sure because of the wrapping. You pay your bill, go home, and find as you unwrap your groceries that at least half of the things you bought were not what you thought they were (or what you wanted), and that there were indeed extra items in there that you never asked to buy.
What kind of crazy scenario is this? It’s a simplified analogy of our healthcare system. The shoppers are patients, club membership is insurance, stores are hospitals, grocery wrappers are healthcare providers, and clerks are the hospital administrators. I also emphasized the lack of price transparency that is inherent in the system.
If grocery stores were actually like this, there would be a violent, nationwide revolt within days. Are consumers ready for a revolution in healthcare? I hope they are, because their collective bargaining power is probably the only thing that will force price transparency and system-wide improvements. But to make this happen, consumers should consider a few key points:
- A single payer model is nothing more than taking the grocery store system we already have and asking the store to accept a new club card whereby staff will decrease the size of the grocery items (by 50%) to those members. One of the best quotes I’ve read about the certain doom of a single payer system was recently posted in GruntDoc’s blog.
- Price transparency is the most important initial step to consumer empowerment and should be at the top of the lobbying list.
- Doctors are not the bad guys, the system is the bad guy. Physicians and patients must ally with one another to demand improvements. The AMA has taken a strong stand in favor of the consumer driven healthcare movement.
- Consumers must become active participants in their care. They need to educate themselves about their diseases and conditions and focus on early intervention and preventive medicine. As resources become more and more scarce, and the US population becomes older and sicker, healthy living practices provide the only real hope of relief from the complications of advanced disease. As Dr. Feld notes in his blog, 80% of healthcare dollars are spent on complications of chronic diseases!
I think that Revolution Health can play a critical role in consumer empowerment. Here at the “Web 2.0” social network intersection between healthcare professionals and patients, RHG can help consumers take control of their health (via education and peer support), and join forces with others like them to revolt against this unacceptable and bizarre “grocery store” system that we have in place!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 11th, 2007 by Dr. Val Jones in News
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Apparently, dentists are now offering feel-good perks to compliment their regular services. One dentist turned her Chicago-based practice into a “dental spa,” complete with free 10 minute massages, cooling eye masks, and peppermint foot scrubs. Cushy lounge chairs, scented candles, herbal tea, soothing music and flat screen TVs adorn the office. Dr. Mitchell says that this is her way of making a trip to the dentist “a really positive experience.”
The American Dental Association estimates that up to 25% of Americans avoid dentists because of fear of pain.
To be honest, I have mixed feelings about spa dentistry. Although I love massages, I’m sure if I were having one at the dentist, the impending doom of drilling and novocaine would diminish my enjoyment. It’s kind of like taking your boyfriend to dinner to break up with him – how much will you really enjoy the meal?
Beyond that, I wonder if the anxiety surrounding dental visits (provided in a spa-like setting) would cause some kind of anxiety transfer to spas in general? I can imagine that if people subconsciously associate foot massages or scented candles with tooth drilling, the next time they get a spa certificate as a gift they may pass it on at a white elephant party.
What do you think? Would you like to see more dental spas crop up across the nation?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 10th, 2007 by Dr. Val Jones in News
4 Comments »
A small pheromone study made a big splash in the media this week, announcing that male sweat contains a chemical that causes arousal in females.
The media’s sensationalization of the study made me feel dubious about the science behind it. I thought to myself, here we go again – some shoddy research and a lot of hand waving… I was determined enough to get the story straight, that I paid my $15 to the Journal of Neuroscience to get my hands on the original data. And I’m glad I did because my suspicions were NOT confirmed.
Claire Wyart et al. at UC Berkeley designed this study well. They took great pains to control the variables, account for confounders, and provide the appropriate environment for the study. “All testing was performed in a temperature and humidity controlled, stainless-steel-coated, 5 x 8 foot room equipped with HEPA (high-efficiency particulate air) and carbon filtration.” Wyart’s team also made meticulous note of previous research on the subject. They also repeated the study just to make sure that their findings were reproduceable. A total of 48 women participated.
In this double blind, placebo-control study they found that exposure to one of the chemicals in male sweat, androstadienone (AND), produced increased cortisol levels, elevated mood, and increased sexual arousal (when combined with provocative videos) up to an hour after the AND was inhaled.
Now, instead of focusing on the enhanced sexual arousal observation (that triggered the media blitz), Wyart suggested an interesting twist: what if AND could be used as a therapy for those suffering from cortisol deficiency (Addison’s disease)? Current standard therapy requires cortisol replacement which may cause peptic ulcers, osteoporosis, weight gain, mood disorders, and other pathologies. But AND is a potential “natural” solution.
Of course, I’m somewhat skeptical of this alternative since Addison’s is generally caused by an autoimmune attack on the adrenal gland cells – and I’m not sure that stimulating what’s left of them (with AND) would result in enhanced cortisol production. Still, Wyart raises an interesting point: what if we could learn how to positively influence the endocrine system with scent stimulation? Could this be a new method of treatment for women with anxiety, depression, or low libido but with far fewer side effects than our current methods?
Well, it’s too early to tell, but I think Wyart’s on to something. As she notes in her research article, AND is only one of hundreds of chemicals found in human sweat, and it is unclear if it is the most potent chemical in the arousal arena. It will be interesting to see if AND is eventually added to perfumes, cosmetic products, and the like as a means of tricking the body into feeling happier, sexier, and more balanced. Science meets aromatherapy? What do you think?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 9th, 2007 by Dr. Val Jones in Opinion
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I’ve invited my Revolution colleagues to form a “blog fodder chain” – when we see something interesting on the Internet, or have a difficult question, we forward it to one another as a kind of challenge to write about it in our blogs.
I have to say, though – they keep sending me the hard stuff. Examples of physicians gone bad, morally questionable healthcare practices, and hot topics full of mine fields. I keep hoping for the “which puppy do you think is cutest?” question. But no such luck for Dr. Val…
Our Chief Privacy Officer challenged me again with some powerful food for thought. A recent article in the New England Journal of Medicine reports that some physicians withhold information (about treatment options) from patients if the physician objects to the options on moral or religious grounds. Med bloggers Kevin MD and Medpundit also have recent posts about this article.
Well, of course this inspires initial indignation. Aren’t physicians supposed to offer all the options, with factual explanations of their pro’s and con’s, and then let the patient decide what they’d like to do?
Well, yes, they are. But the funny thing is that time after time when I’ve tried to do that for patients, they’ve expressed annoyance at me. They say, “you tell me what I should do, you’re the doctor!” And so after hearing this over and over again, I ended up truncating my explanation of options to the most “reasonable” ones and then allowing the patient to ask for more if they’re interested. Am I allowing my personal values to determine the hierarchy of options I present? Yes, probably so.
I’ve noticed that attention spans, even when it comes to important medical decisions, appear to be fairly short. Eyes glaze over when we try to explain all the subtleties of the options, and in the end (if the patient likes you and trusts you as a human being) he or she just wants to know what you’d choose if you were in his/her shoes – and why.
Am I being paternalistic? I hope not. I want patients to choose what’s best for them, but strangely enough their choice is often to let me decide. The power that patients impart to us is an honor and a privilege – and the reason why doctors are held to a higher moral standard than many other professionals. They are right to hold us to that standard. We must not squander their trust.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
