Ever feel like your doctor has no sense of the cost of the prescription, treatment or scan he or she is ordering? In an ideal word, doctors shouldn’t take cost into consideration when choosing care.
But the health care system doesn’t operate in the real world and often that scan doesn’t represent the best care. And, even insured pateints are in for huge copays and deductibles.
Costs of Care is a Boston group that dares to give “patients and their caregivers information they need to deflate medical bills, while expanding the national discourse on the role of care providers in responsible resource stewardship.”
Their effort is part of a new push for transparency in health care pricing.
So, you’re thinking – that sounds familiar? Why didn’t my doc explain the difference in costs when he asked me which hospitals I wanted to go to form my surgery?
Now’s your chance to share that story. The folks at Costs of Care is sponsoring their third annual essay project and they are looking to stories “that best demonstrate the importance of cost-awareness in medicine. Examples may include a time a patient tried to find out what a test or treatment would cost but was unable to do so, a time that caring for a patient generated an unexpectedly a high medical bill, or a time a patient and care provider figured out a way to save money while still delivering high-value care.”
Check out last year’s winners here: www.costsofcare.blogspot.com Entries are due November 15 and all “qualifying submissions” appear on the group’s website. The prize –$4,000.
Note that the contest is sponsored by a slew of insurance companies and Beth Israel Deaconess Medical Center. We note that Partners – famous for its high cost care — is not a sponsor.
Can one state take over its entire health insurance industry? We’ll find out in Vermont. Here are some links w/ more details
From The Rutland Herald:
MONTPELIER — Health care advocates and Democratic politicians on Thursday cheered a Supreme Court decision that preserves the foundation on which Gov. Peter Shumlin plans to build the nation’s first single-payer health care system.
While he vowed earlier this week to proceed with a publicly funded, universal system regardless of how the country’s highest court ruled on the Affordable Care Act (ACA), Shumlin said Thursday that the federal subsidies included in Obamacare will ease Vermont’s transition to single payer.
From Kaiser Health News:
KHN’s Marilyn Werber Serafini talks to Anya Rader Wallack, tapped to move Vermont toward a single payer health care system, who is confident the state would enact its own individual mandate requiring people to buy insurance if the Supreme Court strikes down the federal mandate. Still, finding the money to replace the lost federal subsidies won’t be easy. Wallack says, “We’ll have to cover [people] without adding new resources to the system or raising taxes at the state level. Both of those are difficult for a little state.”
While you’re at it, check out the Health Wonk Review’s two-part take on reform;
As a freelancer, I’ve been known to grumble about doctors who write. After all, why should they hog the Pulitzers and the pages of The New Yorker when they have perfectly good day jobs? On the other hand, doctors in print often offer us an alternative to the mass-marketed Dr. Oz or the perky, laminated docs on daytime TV’s “The Doctors.”
So put down that Parade magazine. (We’ll admit that Dr. O has some good advice about sleeping problems.) Instead, check out the always rich “Ideas” section of The Boston Globe, where you’ll find a column by MGH doc Suzanne Koven on doctors who write.
Perhaps so many doctors are writing literature today as an antidote to our increasingly rushed and technological medical practice. There’s less time or incentive to include, in the modern case history, vivid descriptions of a patient’s appearance, details about his occupation and family life, or musings about what might ail him, than there were 100 years ago. When Oliver Sacks showed his friend, W.H. Auden, film clips of the stiff and mute patients about whom he wrote in “Awakenings,’’ he asked the poet “What do you think they lack?’’ “Music,’’ Auden replied. Doctors who write literature supply the grace notes missing from today’s medical records, recapturing the music of the human condition.
Maybe. The column arrives in anticipation of the release of an anthology “Writer, M.D.: The Best Contemporary Fiction and Nonfiction by Doctors,’’ edited by Leah Kaminsky . And the story includes a list of other works by doctor-writers.
Writing about patients can generate compelling narratives. Try pitching a story on health reform. So, we are surprised to see that you need to buy a ticket for the Cambridge reading Jonathan Gruber’s Health Care Reform: What It Is, Why It’s Necessary, and How It Works. Maybe we should learn to draw: it’s a comic book.
For a more text-based, deeply informed view of politics and health reform, check out the free discussion by Stuart Altman and David Shactman of “Power, Politics, and Universal Health Care’’ on Monday at 7 p.m. at Brookline Booksmith. Altman, a Brandeis professor, has been bouncing back and forth between Waltham and Washington for years. He knows his stuff.
Theirs and ours:
Or listen to Carey Goldberg on WBUR
MassDevice offers : The top medical device stories of the year, Part I
From sweeping regulatory changes promised, but never delivered, by the FDA, to the industry and regulatory backlash against the impending 2.3% excise tax, the industry didn’t move the chains too far in the past twelve months.
The Globe offers Top Ten Health Apps and health advice from “prominant Bostonians.” The list includes dog walking, hoops to stave off Alzheimer’s, meditation, all things in moderation, no desserts –this did not come from the restaurateur –and volunteerism –this did come from a museum director.
The latest edition of the roaming digest of health policy blogs;
The deficit battle is on and politicians are in full voice – both in Washington and out on the hustings, where GOP candidates are loudly denouncing health reform as unAmerican and a job killer. Hipsters and greying hippies are occupying Wall Street and Main Street, while Tea Partiers are claiming they hold the title of most outraged. The one percent is wondering what the 99 percenters are so upset about, while the 99 percenters are after their well-coiffed scalps.
Into the bloody fray, with nary a fear for life or health, reputation or career, plummet our worthies, those denizens of the blog-o-sphere that specialize in separating the non- from the -sense, the BS from the fertilizer, the ill-formed opinion from the logically-based interpretation!
Join us as we follow their heroic deeds, gasp as you read their trenchant and timely missives, awed by their grasp of the incredibly-esoteric and yet critically important.
While health reform may not be at the top of their agenda, some of the Occupy Boston protesters down at Dewey Square had no problem linking the high cost of medical care to their complaints about Wall Street. Some support Obama’s reforms; others called for a single payer system. But, nearly everyone interviewed had universal health care on his or her list of demands.
Even MIT professor Noam Chomsky said the health care system is tainted by what he described as a government dominated by private corporations. Speaking on Saturday night, he told the crowd that the federal budget deficit could be eliminated if the US had a health care system like other countries in the developed world — presumably single payer.
Medicare itself is not the problem, he said.
“It’s a problem because it goes through the privatized, unregulated system,” he said. “It is totally dysfunctional. You can’t talk about this in Washington because of the power of the financial institutions. “
More from the rank and file below.
Damn — scooped again. Every time I go to the doctor and see that sign for “shared medical appointments” I say to myself — good story. Then I remember – I should not reports on doctors in the practice where I get care.
Once when going for a prenatal test at the Univeristy of North Carolina hospital, I lay on the table in a very vulnerable position as a doctor approached me with a very large needle. Didn’t you interview me for a story once? he asked. The giant, disorganized Rolodex in my brain spun and, amazingly, I remembered. I did interview him, but didn’t quote him. Some people take offense to that. Yes, I did and while I didn’t quote you in the story, our conversation helped me get a better grip on the topic. A stock answer but true.
In 2008, Harvard Vanguard began offering “shared medical appointments,” or SMAs. They’re not classes, emphasizes internist Gretchen Gaida. SMAs are scheduled for physicals, well-child checkups, chronic illness management and other types of primary care, as well as for specialty care. Six to 14 patients, who sign agreements to keep information about the others confidential, participate. SMAs last 1½ hours, but patients can leave when they feel their questions have been answered. Doctors take blood pressures and listen to hearts in front of the room but examine patients in a private room when necessary.
Physicians bill the same for patients seen in an SMA or individually. Considering doctors might schedule only four individual patient visits in 90 minutes, Gaida says, income from SMAs enables Harvard Vanguard to pay for the extra health professionals needed to run them smoothly.
Finally, since I’m in rare, chitty-chatty first person mode, check out my post on Nature Network Boston about how that same baby may have been caught up in the Harvard psych research scandal.
Something about Mark Hauser’s now questionable research sounded familiar to me. Then I read that he worked with Harvard researcher Elizabeth Spelke.
Turns out I enrolled my infant son (now 12) in one of her experiments. And the study that appears to be based on the data includes Hauser as a co-author.
A good lesson for journalism students – Always be on the lookout for a story.
A good lesson for hospitals or whoever disposes of their records – Get a shredder!
The Boston Globe reports that one of its photographers was dumping his trash and noticed a huge pile of paper.
Upset that the paper wasn’t being recycled, he looked more closely.
The photographer said he saw health and insurance records from at least four hospitals and their pathology groups — Milford, Holyoke, Carney, and Milton — mostly dated 2009. The Globe notified the hospitals. It is unclear how many other hospitals’ records might have been discarded in the dump.
The hospitals – which found out about the runaway paperwork from the Globe — say their contractor did it.
The breach comes about a year after a Mass General worker left a pile of records on the T, Boston’s subway line.
So, while some worry about the potential confidentiality of electronic medical records, it is worth noting that a of private information leaks out the old fashioned way — on paper.
The paper also reports that the Cambridge Health Alliance – which runs the region’s “safety net” hospital, is looking for a buyer. Partners has passed on it. The group is now reporting talking to Caritas Christi, another struggling area hospital chain slated to be taken over by a for-proft group.
Somehow “safety net” and “for-profit” don’t seem to work in the same sentence. Stay tuned.
In other health finance news this week, The Boston Business Journal reports that insurer Harvard Pilgrim Health Plan is moving toward global payments. The story describes the move this way:
Global or “bundled” payments reimburse health care providers per patient, or per medical episode, rather than per service. Proponents of global payments say that it discourages unnecessary tests and puts the focus on preventive care and healthy outcomes, rather than on expensive hospital stays
The story points out that a state committee looking at health care costs endorsed the approach last summer:
The Special Commission viewed global payment models as having important advantages. They offer strong incentives for the efficient delivery of the full range of services that most patients need. They emphasize primary care and reinforce the goals of patient-centered medical homes. Moreover, some Massachusetts providers already have operational experience with some form of global payment. An estimated 20 percent of commercial physician payments are currently made in Massachusetts under some form of global payment (Bailit 2009). This experience suggests that broader adoption is feasible (since many providers already are managing under it successfully) and provides a base for wider progress towards global payment.