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What does quality mean? How do you find it? Dr. Jay Parkinson tells all

Posted by on July 10, 2016

Summary: How do you pick a doctor? Here’s a great handbook by Dr. Jay Parkinson, who’s a co-founder of Sherpaa. “During my preventive medicine residency at Hopkins I worked in Dr. Peter Provonost’s Institute for Patient Safety and Quality,” Jay writes on his blog. “In addition to leading all safety and quality issues at Hopkins, he’s also credited with creating the concept of the surgical checklist, a tool that’s proven to save a significant number of lives and best described in Atul Gawande’s book, The Checklist Manifesto. Peter taught me that everything is a process, and if you don’t design the process with intention and outcome in mind, the process evolves into the easiest, rather than the safest. That being said, in healthcare, I deify process mostly because the data on individual physicians isn’t plentiful enough to be statistically significant … For example, a surgeon who does 32 tonsillectomies a year isn’t enough data to be scientific. It’s meaningful because it’s common sense that you almost always want to go to the surgeon/facility who does the most of the exact thing you need. But, you need much, much more volume than that for the outcomes to be scientifically statistically significant. Physicians are also always taught that the practice of medicine changes every 5 years. New evidence comes out and gold standards change. This also throws a wrench in the concept of studying doctor quality. …It’s also relatively common knowledge that the older the physician, the further they are from state of the art training. … Older physicians, unless they take it upon themselves to learn new procedures through curiosity and continuing medical education, will likely be doing an exceptional job with out of date procedures. Younger physicians will be doing state of the art procedures with less experience.” Dr. Jay Parkinson, “What does quality mean in healthcare and how do you find it?” his blog.


Negotiator Lowers Medical Bills, and You Can Too: Health News Florida

Posted by on July 8, 2016

Summary: “Medical debt is one of the leading causes of bankruptcy in the United States,” our partner Sammy Mack writes over at Health News Florida. “Having health insurance is no guarantee against being swamped by bills after an emergency or a big procedure. But one Palm Beach County man has found there’s room to negotiate. Kenneth Klein is a former attorney who now runs the business Human Health Advocates—he works with clients to renegotiate bills and resolve insurance disputes. You can hear his conversation with Health News Florida here. Sammy Mack, The Negotiator: He Lowers Medical Bills — And You Can Too,” Health News Florida.


A discussion of drug prices from a thinkfest in Aspen

Posted by on July 2, 2016

Summary: Here’s the transcript of a thoughtful panel discussion on drug prices from the Aspen Institute, involving Zeke Emanuel, the co-founder of Blink Health, a Consumer Reports person, a hospital representative, and a pharma person, among others. Read and weep. Sample passage: “She did what thousands of Americans did and have told us that they do, when a price hike is this profound, they just walk away from the prescription. She did not fill the prescription, so as many physicians in the audience, you know that by not taking your rheumatoid arthritis treatment, not only do your symptoms get worse but the actual disease worsens. … her doctors were furious at her because that she had become debilitated from not taking her drugs. She couldn’t even do normal household chores. She finally went online and through using some coupon, discount coupon services … she was able to get the price down something closer to $300. Now that is still a profound amount for her. She said she struggles with this. Marlene and her situation, we estimate she was one of 33 million Americans just in the last 12 months who told us that their drug prices had hiked unexpectedly at the pharmacy counter for drugs they take all the time. So it’s not just high-end very expensive drugs, it was old school generics. It was branded drugs, it was everything.” Source: “Deep Dive: Drug prices and access to medicine,” The Aspen Institute, June, 2016. Participants: Kirsten Axelson, Pfizer; Geoffrey Chaiken, Blink Health; Ken Davis, Mount Sinai Health System; Ezekiel Emanuel, University of Pennsylvania; Lisa Gill, Consumer Reports; Kiah Williams, Sirum; Alan Weil, Health Affairs.


Rising deductibles, and inadequate coverage: Drew Altman at the WSJ

Posted by on July 2, 2016

Screen Shot 2016-07-02 at 10.38.04 AMSummary:With 91% of the population now covered by some form of health insurance, and the coverage rate higher in some states, the next big debate in health policy could be about the adequacy of coverage,” Drew Altman, head of the Kaiser Family Foundation, writes over on The Wall Street Journal. That particularly means rising payments for deductibles and their impact on family budgets and access to care. This is about not just Obamacare but also the many more people who get insurance through an employer. As the chart above shows, payments toward deductibles by consumers who have insurance through large employers rose 256% from 2004 to 2014; over the same period, wages increased 32%. The chart shows what people actually paid toward their deductibles and other forms of cost-sharing, not just their exposure as deductibles climbed (which is more typically what studies and data report). Deductibles accounted for 47% of cost-sharing payments in 2014, up from 24% in 2004. During the same period some other forms of cost-sharing fell. Payments for co-pays declined by 26%. It’s no wonder that consumers say in polls that deductibles are their top health-cost concern.” [Note the coinsurance rising on this graph also.] Drew Altman, “The Next Big Debate in Health Care,” The Wall Street Journal.


Where does it cost the most to see a doc?

Posted by on July 1, 2016

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Summary: “Since the depths of the Great Recession, the cost of health care in the U.S. has steadily risen,” Nick Selbe writes at “As a result, Americans are shouldering more of their health care costs than they have in recent years, according to the Washington Post. No one likes having to go to the doctor’s office, but in this climate, it’s wise to save up should the need arise. With this in mind, CareerTrends — part of the Graphiq network — found the 50 places where seeing a doctor costs the most. The data comes from the Council for Community and Economic Research’s Cost of Living Index (2015). The report is compiled by pricing the cost of a general practitioner’s routine examination of an established patient across different locations. Of the top 50 most expensive locations, the Midwest is the region with the most representation. A visit to the doctor in each location costs over $120, and the 10 most expensive places have prices over $160.” Nick Selbe,
“Where does it cost the most to see a doc? Wisconsin ranks high,”


18% of cancer patients can’t afford medication, study finds

Posted by on June 24, 2016

Summary: “Financial pressures kept cancer patients from filling prescription medications and attending their doctors’ visits, University of North Carolina Lineberger Comprehensive Cancer Center researchers found in a new study,” according to a press release from the center. “More than one-in-four cancer patients surveyed reported they had to pay more for medical care than they could afford, and 18 percent of those patients said they were unable to afford prescription medications.The findings (abstract 6624), presented Saturday, June 4, at the American Society of Clinical Oncology Annual Meeting 2016 in Chicago, raised concerns for the researchers about access to much-needed care for cancer patients – an issue they believe will only increase as the cost of treatments has climbed significantly.” “Cancer Patients Miss Appointments, Prescriptions Due to Inability to Afford Care,” University of North Carolina Health Care System.


Changing prices: Trends overall, and in Texas, from year to year

Posted by on June 21, 2016

6793817419_5bafb78aabSummary: Watching cash prices in health care, as we have for the past five years, we have noticed a few trends. Here’s one: cash prices vary across a fairly narrow band, in most cases, for most things. Another: More and more providers are quickly able to quote cash prices than were able to do so when we started doing this in 2011. Yet another thing: Prices charged by providers to insurers and others can vary a lot, and prices paid by insurers to providers can also vary a lot. And finally: the intermediation of the insurance system (a third-party payer) can really affect what you’re charged and what you’ll pay.


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Californians more worried about health costs than about whether they’re insured: L.A. Times

Posted by on June 11, 2016

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Summary: “Six years after President Obama signed the Affordable Care Act, the health reform law has gained acceptance from a majority of California voters, but the cost of getting healthcare remains a major concern, eclipsing worries about having insurance, according to a new USC Dornsife/Los Angeles Times poll,” David Lauter writes in The Los Angeles Times. “The widespread worry about costs indicates a potential shift in the debate over healthcare, at least in this heavily Democratic state. … Cost concerns were most widespread among those in their 50s and early 60s. Indeed, that age group consistently showed the highest levels of anxiety on a series of healthcare concerns. By contrast, those over age 65, most of whom are covered by Medicare, were the least likely to express worry about healthcare issues. … Just over half of those surveyed said they believed that costs for average Americans have ‘gone up a lot’ because of the law, compared with roughly one-third who said that the law had not caused that to happen.” David Lauter, “California voters are becoming more concerned about healthcare costs than about whether they have insurance,” The Los Angeles Times.


How much does a brain MRI cost? Well, $250 or $1,850, or $8,000

Posted by on June 8, 2016

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Summary: How much does a brain MRI cost? Well, $250 or $1,850 — or $8,000. “Had a problem with high deductible insurance. I decided not to deal with the insurance and just pay out of my HSA. The bill said my balance was $1850.00, however it also had a handwritten amount of $250.00. Not sure why the discrepancy happened, but the price I paid was $250.00,” said the note on the PriceCheck contribution in our Florida partnership. So I reached out to the contributor to ask about her $250 brain MRI.


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‘Value Creation’ And ‘Value Shifting’ In Health Care: Uwe Reinhardt

Posted by on June 4, 2016

Summary: Princeton economist Uwe Reinhardt writes about value shifting in health care in the current issue of Health Affairs. The money quote, for me: “My gratuitous advice to the drug industry, and to the health care industry in general, is to be very mindful of the distinction between value creation and value shifting in their pricing policies, lest they eventually invoke the wrath of the losers in that game, with dire consequences. A healthy addition to corporate board meetings at these companies, for example, might be a presentation on the distribution of family income in the United States, whose median now is around $52,000 (meaning 50 percent of American families have a lower family income). Similarly, the boards should know more about the health insurance status of the American people, including the ever-increasing deductibles and coinsurance families are made to bear. These data might give boards some feel for how much money can reasonably and humanely be extracted from their fellow Americans, especially those in the bottom half of the income distribution, with whom the boards and business executives have lost touch.” Uwe Reinhardt, ‘Value Creation’ And ‘Value Shifting’ In Health Care, Health Affairs.


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