cost cutting edition

April 10, 2017 By e-Patient Dave Leave a Comment

Do you understand your healthcare costs? See what New Orleans is finding.

For years I’ve blogged about the difficulty of shopping responsibly for healthcare. Well, late last week some big news broke – big enough that I did an overnight makeover of my home page and added a new page to my site. This is the first chance I’ve had to blog about it.

The news is that the work of my longtime friend Jeanne Pinder at ClearHealthCosts is finally getting the widespread attention it deserves: in New Orleans, award-winning investigative reporters at both Fox 8 TV and the Times-Picayune newspaper have dug right in and started using the ClearHealthCosts software system both to report the insane price variations and, importantly, let the public submit more to flesh out how much is known.

Fox 8 reporter Lee Zurik fired the first salvo, a 7-1/2 minute long segment – which, as you know, is a huge length of time for an evening news piece. Then Times-Picayune investigative reporter Jed Lipinski posted his separate piece – see screen capture above.

Here’s my page on the series with links to both pieces and all my past posts: Cracking the Code.

More to come, and here’s hoping many cities follow. We, the suffering consumers, danged well deserved to know where our money is going, and we deserve to know what our options are, before the bill arises.

April 12, 2016 By e-Patient Dave 6 Comments

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

$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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September 15, 2015 By e-Patient Dave 8 Comments

Article in USA Today soon with my opinion on costs, and online advice

Photo of e-Patient Dave — Photo by Zack DeClerck for USA Today. (Click to link to article)

I was interviewed recently by USA Today reporter Laura Ungar of the Louisville Courier-Journal. The story ran Monday 9/14 in that paper and will be in the national USA Today soon. (I expected it on Tuesday 9/15 but it’s not there.)

The subject is summed up perfectly by the headline: Wildly varied health costs a national mystery.

Regular readers of this blog are familiar with my years-long series of posts Let Patients Help: Cost-Cutting Edition, especially my efforts to shop responsibly to get a skin cancer treated. If you’re not familiar with it, and you have the stomach for it, sit back with a cup of your favorite beverage and start digging. (For a shorter version, read the final post, which is pretty unsettling.)

Why do I ask you to read it? Because I believe this is important to the future of health(care) in America. We must put an end to this crap. Providers, give us the facts! Tell us what things will cost, so we can decide what’s important to us!

Good providers who are trying to do a good job at a good price simply cannot win our business in an environment that, 9 years after the original article in Health Affairs, is still best described as that article’s title did: “Chaos behind a veil of secrecy.”

Can you believe that this situation is tolerated and nobody is getting busted? As I told Laura in the interview:

There can be no explanation other than some secret malarkey going on. …

I feel disempowered and disrespected, because aside from the incredible cost crunch we’re all experiencing, it’s a downright sin that my family can’t readily find out what the options are and what the costs are.

Remedy: information!

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August 21, 2014 By e-Patient Dave 20 Comments

Six month countdown to Medicare! What do I need to know?

65th birthday cake by Oana Go (Germany). Click to view project on Craftsy.

Yesterday I blogged about my business’s fifth birthday … and this week, it turns out, marks six months before I turn 65!

And that means I go on Medicare.

I’ve learned enough in these five years to know at least two things:

You’re a patsy if you think the American medical system will necessarily take care of you. It might, but if it does, it may be in the process of making itself a boodle of money.
- Yes, there are many exceptions – individuals and organizations who care and who work hard. But I’ll repeat: you’re a patsy if you sit back and assume the system will take good care of you.

When it comes to money in American healthcare, don’t expect anything to be explained clearly.
- 18 months ago I blogged about a famous policy paper, Hospital Pricing in America: Chaos Behind A Veil of Secrecy by Princeton economist Uwe Reinhardt. That paper was published 8 years ago, and hardly anything has changed. (The title of the article is real and not an exaggeration.)
- In 2013 I lived the chaos and the veil myself, in my own shopping for everything from CT scans to shingles vaccines to skin cancer treatments. I saw at close range that Reinhardt was not exaggerating, and I blogged it in a series called “cost-cutting edition.”

There are signs of hope, such as ClearHealthCosts, but although I work for change, I’m not waiting for the posse to save me.:-) I’m gonna be pro-active, engaged, empowered, responsible! I want to get educated, because I’ll be on Medicare for the rest of my life. And I want to approach the education from the patient’s perspective … not what the system wants to tell me, but what people like me have found necessary.

So, you who’ve been through it: what do I need to be aware of? What choices will I need to make?

I do know these things about Medicare: [Read more…]

March 11, 2014 By e-Patient Dave 64 Comments

How much should/could this pathology cost? (Skin cancer biopsies)

I’m going to START with three clarifications, because sometimes people don’t read footnotes. :-) Read before proceeding.

I’m NOT saying there’s anything wrong here – don’t anyone assume that every time I blog, it’s a warpath. :) I’m just asking a question. My guiding principle on medical treatments and costs is that people should know what their options are, so I’m presenting my situation and asking.

I’m also NOT asking for treatment advice – I’m only asking about costs and whether it sometimes makes sense to get pathology done elsewhere. (We’ve already discussed treatments and I’m satisfied.)

As I’ve said before, I’m NOT recommending that anyone else act as I choose to.

Also, regular readers know that as a former cancer patient in New Hampshire, my insurance options were limited, and I chose $10,000 deductible, so all of this will come out of my pocket. As I’ve blogged many times before, this turns out to be a nifty way to discover how the money actually flows in American healthcare, which is usually really hard to find out.
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Below is the pathology report from some biopsies I got in January. The bill is $416 list price; after the usual insurance discount, my balance due is $312.

My questions:
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February 7, 2014 By e-Patient Dave 2 Comments

A new era: the “consumer-patient,” via Inquire Healthcare

A new website launched last month. I’m not involved with the organization, but I almost wish I were, because what I’m seeing is what I hope we’ll see everywhere, for every medical need.

The site is InquireHealthcare.org, a project of the non-profit Health Care Incentives Improvement Institute (HCI3). It’s the first time I’ve seen a new term that I love: “consumer-patients.”

(Some activated consumers hate the term “patient” and some activated patients hate the term “consumers.” My own views are in the glossary of Let Patients Help. Here I want focus on what you get when you mix the best of both – because that’s what they’re after on this site.)

It’s got three things I’ve never seen combined: shopping tools, self-assessment tools, and community activist tools. How’s that for a toolbox to create change? (Again, I wish I were bragging about my own work, but I never heard of them until they launched.) Specifically:

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