epatient dave skin cancer blog

One of the most interesting people in the online health world is e-patient dave.

So we were shocked the other day to read that he has cancer again — and also that he has put out a request for proposals (RFP, or, in other words, a bid) to get pricing for his treatment.

He’s got an enormous following and a terrific story — his kidney cancer diagnosis n 2007 essentially was the catalyst that made him into an international expert on health care reform, patient engagement and the health-care ecosystem in general. He’s a national treasure, with 9,600 twitter followers and a devoted cadre of readers (including me).

Here’s the RFP post on his blog: he’s engaging his readers in a conversation about costs, and patient engagement, and morals and all sorts of other things.

The post is well worth reading for its matter-of-fact tone, and also for its informative (and occasionally wry) nature. The comment thread is also pretty terrific.

Here’s an interesting response, from a doctor:

“A frequent criticism of American Health Care is that pricing is not transparent. There are reasons for that, but they are not conspiracy theory worthy, usually its because we often don’t really know. Sometimes we liken it to calling up a restaurant and demand to know how much your meal will cost; they are at a bit of a disadvantage without knowing what you are going to order. Well, the doc does not fully know what is going to happen when we see you. There is nothing conspiratorial about it; you may present with a ‘spot on the face’. We might know right away that it is a benign lesion (non-cancerous) that requires reassurance and not testing or treatment. Cost – maybe $50-$150 depending on the doc. It may end up being a metastasis from an internal tumor – biopsy, imaging, hospital stay, major tumor resection, lab work, a complication in hospital, one night in intensive care (expensive scare), cost $350,000. So how much is a spot on the cheek going to cost – ‘it depends’– you darn doctors are hiding something. You get the idea –

“well here is your answer

“no treatment – free – done if you have a serious other condition that is likely fatal in the next 6 months, we would advise against getting this treated, there is no point, it drives up the bill and gives you no real benefit, unless it is symptomatic.

“A simple scraping procedure in office, under local anesthetic, wound heals by itself – ?$200 ?$300

“A prescription anticancer cream- used off label when on the face – buying without insurance $750, but if there is some sort of insurance then discounted to anything from $20 co-pay to maybe half the cost of the drug. …

“As you can see we need more information from you to make sensible recommendations. There is a lot that goes into medical decision making and much of it happens behind the scenes, it may not always be conveyed to the patient. ….

“My bottom line though is that this lesions could probably be treated for between $300 to $3000, in that sort of range.”

It’s kind of like the saga of the $23,000 circumcision  chronicled over on HealthcareSavvy and the CommonHealth blog at WBUR, and Rachel Zimmerman’s ultrasound pricing saga at CommonHealth.



Jeanne Pinder

Jeanne Pinder  is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded...