e-Patient Dave

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The difficulty of shopping when they hide the facts: that skin cancer RFP in the NY Times

NYTimes Tina Rosenberg clip 4-12-16$5,000-$7,000?  $1200-$1500?  $868?  What should it cost to remove a simple skin cancer? What if you can’t find out?

Long-time readers know that in 2012 I was on high deductible insurance – and I don’t mean Obamacare-style $3,000 deductible, I mean $10,000 deductible. I chose that gladly, because I had laboriously analyzed the five plans available to me. I know insurance is a game of sharing risks, so I analyzed (it took all my Excel skills) and chose.

What happened next is described in a column in today’s NY Times by Tina Rosenberg, Shopping for Health Care: A Fledgling Craft: within months I discovered I had a skin cancer on my face. I became a highly motivated shopper, and quickly discovered nobody could tell me what would be on my bill.

The details are in several skin cancer posts here. But Tina Rosenberg writes about social problems, and I want to draw attention to the nature of this social problem: it withholds power from the person whose health is at stake, and that’s just plain wrong.

Here’s the World Bank’s definition of empowerment, from a January post:
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I’ve started an RFP for my skin cancer

RFP thumbnail (click to visit the document)

Be sure to scan the 57 comments readers added, below.

The other day I announced my new skin cancer diagnosis and discussed how I’ll blog my approach to it as an e-patient.

I’ve decided to explore my options by doing what companies do when they’re shopping for a solution: they write a Request for Proposals, and let vendors reply. But in this case what I published isn’t cast in stone – I invite discussion and suggestions. And, significantly, I start with the context: partnership; participatory medicine –

I’m approaching this through an RFP process because I believe in “participatory medicine,” in which patients play an active and responsible role in all aspects of healthcare. I believe patients should play an active role in making care more cost-effective and patient-centered, by being responsible about costs and by saying what they want.

 

Here’s the RFP, in Google Docs. At top right of that page there’s a place to leave comments, or discuss here. Thanks for helping!

Update: This triggered an enormous amount of discussion on social media, additional posts here (with the results of my shopping), and even an article four years later in the New York Times, which I posted about with additional thoughts and resources. [Read more…]

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“What will this cost?” Episode 4 of Power of the Patient, with Clear Health Costs

Episode 4 of the Power of the Patient podcast is live here.

Want better control over your health costs? Investigative journalism has finally come to healthcare, and it’s winning prizes bigtime.

My guest Jeanne Pinder is a former New York Times editor whose company Clear Health Costs has just won the Edward R. Murrow award for investigative journalism, for their contribution to the “Cracking the Code” series in New Orleans. [Read more…]

New Orleans investigative reporters expose health cost craziness, with ClearHealthCosts

Click to see the Times-Picayune article
Click to see the Times-Picayune article

Video of the first episode is below.

Last updated April 10, 9:30 pm ET.

Regular readers know that among my various causes – patient-centered care, patient access to our medical records, etc – is the importance and challenge of managing our health costs. For years I’ve blogged about my own experience – see the list of posts below. Occasionally I’ve blogged about my friends at ClearHealthCosts, who have been busting their butts to … well, make health costs clear. And for years I’ve wished we had more public attention on this crazy situation. Because when costs are chaotic, it can be hard to get the care your family needs without getting hurt in the process. How ironic is that?

So I’m thrilled to say that WVUE in New Orleans (“Fox 8 NOLA”) started a new series April 5, “Cracking the Code: The Real Cost of Health Care,” followed immediately by a print series by the Times-Picayune‘s Jed Lipinski.  From what I’ve seen so far, each is spot-on. ClearHealthCosts is a big part of the project.

To my surprise a simple Skype interview that I did was used in the first TV episode. I can’t wait to see more.

It’s all new so for the moment I’m quickly adding this page to my site … I’ll update it when I can. For now, here’s video of the first episode, and below are my past posts on health costs. I hope it helps.

FOX 8 WVUE New Orleans News, Weather, Sports, Social

My past posts on figuring out health costs

You can also browse my entire cost-cutting category.

4/12/16: The difficulty of shopping when they hide the facts: that skin cancer RFP in the NY Times

9/11/15: Article in USA Today soon with my opinion on costs, and online advice

3/11/14: How much should/could this pathology cost? (Skin cancer biopsies)

2/7/14: A new era: the “consumer-patient,” via Inquire Healthcare

6/5/13: “Chaos, behind a veil of secrecy”: Show me the cash flow

4/25/13: The reality of shopping for health insurance (pre-Obamacare)

3/25/13: An encounter with the Swiss medical system

3/11/13: The Big Ugly continues: “Hospital charges bring a backlash”

3/4/13: Let Patients Help, Cost-Cutting Edition: “Chaos behind a veil of secrecy”

1/6/13: Pricing visibility – video interview with HealthWorks Collective

12/11/12: Reprise: The healthcare waste pit is BIGGER than the fiscal cliff.

11/11/12: Great Robert Wood Johnson video “This Cost How Much?”

10/1/12: Perceptions creating reality: the scapegoat dynamic and the role of the patient

6/16/12: A dermatologist responds: “Who the heck is charging $3000 for Mohs first stage?”

5/21/12: Raw numbers for treating my basal cell carcinoma at three hospitals

5/10/12: Decision: Just scrape it off. (“ED&C”)

3/25/12: Let Patients Help, Cost-Cutting Edition, Part 3: Shopping for my next CT scan

2/20/12: It turns out being an engaged patient/consumer takes time.

2/11/12: I’ve started an RFP for my skin cancer

2/9/12: Time to practice what I preach: I have skin cancer again.

1/9/12: Let Patients Help, Cost-Cutting Edition, part 2: Shingles vaccine

11/5/11: Let Patients Help, Cost-Cutting Edition, part 1: a bill.

 

 

 

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The Garfield Project: learning from the death of our 20th President

James Garfield (from WhiteHouse.gov)
James Garfield (source: WhiteHouse.gov)

One of my most potent, visionary, and interesting clients this year was back in February – St. Luke’s Health System in Boise. (Did you know Boise is pronounced Boissy, not Boizey?)

I could say a lot about the time I spent working with them. Their CEO David Pate had heard me speak a year earlier at a small CEO roundtable, and subscribed to this blog. When I posted my RFP for my skin cancer, he wrote and said “I’ve got a proposition. Come do your talk as Grand Rounds, and we’ll do the surgery for free.” I said “Thanks but no thanks – but since you asked…” and we started a discussion that led to a multi-day engagement, working with their leadership team and giving a keynote to a big leadership meeting last winter.

I subscribed to his blog too, and in today’s feed is a fascinating story: Learning from the 20th President. That president was Garfield, who died 132 years ago. He was shot, but the bullet didn’t kill him – an infection did, months later, almost certainly caused by the stream of doctors who stuck their unwashed fingers and tools in him to try to find the bullet.

[Read more…]