Archive for Healthcare price transparency

Feb
21

How much does it cost to get irretrievably pissed off?

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Nothing. It’s free. Just costs a little of your time.

First, a piece from the New York Times magazine on the science of making addictive foods.

addictive foods image

image credit: Grant Cornett | NY Times

Second, a post on the TIME Healthland blog about the insanity that is medical billing.

TIME cover

image credit: TIME Magazine

Go ahead. Read, get angry, get engaged, DO SOMETHING.

Lather, rinse, repeat.

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Hang on to your hats – this one might wade into controversy.

django lincoln caduceus imageAs I write this (3:30pm EST on January 1, 2013), I’m listening to a conversation on NPR about the Emancipation Proclamation, which was signed into law by Abraham Lincoln 150 years ago today. I’m also reflecting on a couple of movies I’ve seen in the last 45 days: Lincoln (over Thanksgiving weekend) and Django Unchained (on Christmas Day).

Is it time for an emancipation proclamation for patients? Or should we just saddle up and have a shootout at the plantation … um, hospital instead?

Too many healthcare transactions are still conducted over the patient’s supine form. Doctors, hospitals, and other entities in the “provider” column horse-trade with health insurers, including Medicare, in the “payer” column. That means that the patient winds up shackled. No say in how much something costs, no real voice (yet) in what happens next, little interest on the part of the two trading entities in clueing us in to what’s happening.

Some of my connections in the participatory medicine/e-patients movement use a driver-rider metaphor for transforming healthcare, with the patient moving from passenger to driver in healthcare. It’s a less controversial/confrontational metaphor than referring to patients as chattel on the medical plantation. However, I’m sticking with that plantation metaphor for the moment, because too many in the provider and payer camps are still viewing patients as meat puppets, not as full participants.

Does healthcare need an emancipation proclamation? Yes. Here’s where the metaphor shifts: let’s not wait for someone to proclaim us (patients) emancipated. Let’s break our own chains, and be our own liberators.

Let’s demand that the providers and the payers give us an equal seat at the table, and then let’s …

LEARN EVERYTHING WE CAN TO BE PRODUCTIVE CONTRIBUTORS TO THE HEALTHCARE SYSTEM.

That last statement is the core of what will emancipate healthcare: patients, providers, payers, caregivers, everyone. Shared decision making – along with “patient-centered”, that’s the new hot phrase in healthcare – can only exist if all parties are able to participate in sharing the decision-making. We must learn how to understand the language of medicine, including research statistics (by the way, many doctors aren’t great at that, either). We must learn to apply critical reasoning to what we see/hear/read in the media about risks and trends in health and disease. We need to work on getting a seat at the research table to give a hard shove in the direction of making clinical research less ivory-tower and more boots-on-the-ground.

Some recommended reading for those who’d like to emancipate themselves:

Society for Participatory Medicine blog

ePatient Dave

Susannah Fox

Dr. Ted Eytan

and our movement’s own Rosa Parks (or, dare I say it, our own Django?):

Regina Holliday

Let’s liberate ourselves, shall we?

Accountable care. That’s one of the central pillars of healthcare reform/Obamacare/the Affordable Care Act. Given that Obamacare is built on transforming Medicare, the payment system from which all Holy Billing Codes and the pricing attached thereto flow, Accountable Care Organizations (ACOs) would seem, given their name, to be about accountability for care, right?

Not so fast. The “accountable” in ACOs has more to do with accounting than accountability. An ACO is defined as a network of doctors and hospitals that shares responsibility for providing care to patients. In essence, that network agrees to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years. The ACO is indeed accountable for providing care, yet that 5,000-Medicare-beneficiaries-for-three-years is as much about accounting as it is about patient care.

Real accountability in healthcare is an elusive thing. I’ve said many times, here and elsewhere, that there are no guarantees in medicine, other than that there are no guarantees in medicine. That does not mean, though, that we should expect mistakes. Medicine is a human effort, with human failings embedded within it. We should help ourselves, and the medical-industrial complex, though, by taking advantage of the information available to us – patients, providers, all of us – to determine where to get the best and safest care.

jeopardy clue tileAccountability, in the accountable-actions definition, was codified in a California law that went into effect on January 1, 2007. That law gives the California Dept. of Public Health the power to fine hospitals up to $100,000 per event for what they call “immediate jeopardy”, which is defined thus: An immediate jeopardy is a situation in which the hospital’s noncompliance with one or more requirements of licensure has caused, or is likely to cause, serious injury or death to the patient. A situation is an immediate jeopardy at the time it occurred.

Let’s play Immediate Jeopardy! I’ll take Medical Errors for $100,000! And the question is, “How much were California hospitals assessed in the most recent immediate jeopardy bitch-slap, Alex?” [the answer is in the blue tile]

Since the California law went into effect, 254 immediate jeopardy errors at 141 hospitals have been identified and fined, for a total of $10.4 million. $7.6 million of that has been paid. An article on Health Leaders Media gives the full story on the most recent round of errors, and the fines assessed. There’s also a link to the California Dept. of Health site, where all the incidents and fines since the law went into effect are available with just a few clicks. Some of those reports are truly alarming, even though they’re written up in very spare prose.

Here’s where becoming an e-patient delivers solid value: you learn how and where to look for reliable metrics on healthcare. Anyone can be an e-patient. Here’s how it worked in this instance, when I wanted some additional context for what I read in Health Leaders.

I read the article, and then, in a new browser tab, surfed over to a recent post on e-patients.net about the new Hospital Safety Score tool from The Leapfrog Group. I hunted up the safety scores – which run on an A through F scale, just like a school report card – for the 10 hospitals fined in the most recent round of Immediate Jeopardy. What I found was this:

  • Five of the fined hospitals were A-rated, yet one of them was fined at the highest level ($100K), twice, for repeated incidents
  • Of the other five facilities, two had B grades, and three got Cs

What did I take away from this dive into the medical-quality-metrics pool? What I take away from each dive I make into the healthcare ocean: transparency in healthcare is still in its infancy, but it’s getting clearer and clearer every day. Will it ever be crystal clear, letting patients make choices that are 100% guaranteed to have a great outcome? Please re-read the 3rd graf of this post for the answer there (hint: it’s “no”).

What we – patients, providers, payers, all of us – can do to make healthcare as clear and careful as humanly possible is to continue to call for immediate reporting of problems, to participate fully in each transaction we have with the industry, to share lessons learned when outcomes don’t match reasonable expectations. By helping each other heal the system, we can help heal ourselves in the process.

Everybody wins.

Dec
20

Terminating the doctor-patient relationship …

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you're fired sticky note imageInspired by this, I wrote the following.

The first list is from the linked post, the second is my take. In the wake of recent #epicfail blogging by rheumatologists, I’m semi-amazed that this “how to terminate” thing got posted, although I’m only semi-amazed …

Grounds for Terminating the Physician–Patient Relationship

A successful physician–patient relationship must be based on mutual trust and effective communication. When these elements break down, it is likely in both parties’ interests to terminate the relationship. Common reasons for terminating the physician–patient relationship include:

  • The patient fails to pay his/her bills.
  • The patient continually cancels or misses appointments.
  • The patient is rude, disruptive, uses improper language, exhibits violent behavior, or threatens the safety of the office staff or other patients.
  • The office staff is uncomfortable working with or communicating with the patient.
  • The patient is dissatisfied with the care he/she received from the physician.
  • The patient requires more highly specialized services than the physician can provide.
  • There is a conflict of interest between the patient and the physician (e.g., the physician’s religious beliefs preclude him/her from providing certain treatment options, or the physician has a personal or financial interest in the treatment option).
  • The patient is habitually uncooperative and refuses to comply with the treatment plan.
  • The patient fails to complete a series of treatments.
  • The patient is unreasonably demanding.
  • The patient did not provide an honest medical history or was misleading in the information he/she provided, thereby compromising the efficacy of treatment.
  • The patient develops a personal interest in the physician. Examples include excessive contact with the physician, demanding the physician’s time in the absence of a legitimate or urgent medical need, or becoming angry or unreasonable when the physician is unavailable.
  • The physician develops a personal interest in the patient. Examples include consultations that involved discussion of information not relevant to the patient’s treatment (e.g., details about the physician’s personal life), the physician becomes attracted to the patient, or the physician acted in a manner that would be deemed inappropriate by his/her colleagues.
  • The patient filed a complaint or initiated a legal proceeding against the physician.

Grounds for Terminating the Physician–Patient Relationship (Patient Version)

A successful physician–patient relationship must be based on mutual trust and effective communication. When these elements break down, it is likely in both parties’ interests to terminate the relationship. Common reasons for terminating the physician–patient relationship include:

  • The physician consistently fails to disclose the cost of treatment.
  • The physician habitually leaves the patient lounging, in a gown, in a cold exam room, for thirty minutes or longer. Every damn time.
  • The office staff behaves like a military guard in East Berlin in 1964: officious, unpleasant, and armed with strange weapons, including the ability to deny the patient access to her records.
  • The office staff entertains itself by running the patient around in circles when trying to schedule appointments, get test results, renew prescriptions, or get phone access to clinical staff.
  • The patient, after months/years of treatment, still feels like hammered whale shit.
  • The patient requires more highly specialized services than the physician can provide. Like, say, kindness. Or actual help.
  • There is a conflict of interest between the patient and the physician (e.g,, the physician is a paternalistic fuckweasel, and enjoys offering the patient hope, only to snatch it back because that treatment isn’t covered by the patient’s insurance).
  • The patient is habitually uncooperative and refuses to comply with the treatment plan, reportedly because after months/years, IT STILL ISN’T WORKING.
  • The patient fails to complete a series of treatments. Because that series keeps getting longer, changing, try-this, try-that, world without end, amen.
  • The physician thinks the patient is unreasonably demanding. (“Bitch wants to be pain-free. As if.”)
  • The physician believes that the patient did not provide an honest medical history or was misleading in the information he/she provided, thereby compromising the efficacy of treatment. (“Lying, drug-seeking bitch. For realz.”)
  • The physician thinks that the patient has a personal interest in the physician. Delusions include perceived “excessive contact with the physician” (patient solely attempting to get an appointment sooner than 12 weeks out), demanding the physician’s time in the absence of a legitimate or urgent medical need (“because we all know bitch wants to be pain free”), or becoming angry or unreasonable when the physician is unavailable (“because bitch is still on that damn pain-free bus!”).
  • The patient filed a complaint or initiated a legal proceeding against the physician, because bitch just wanted to be pain free but discovered she’d been given a medication that caused random side effects like anal bleeding and liver failure.

 

 

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Nov
12

How much IS that? I’m not the only one who thinks that’s a great healthcare question …

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Thanks to ePatient Dave deBronkart, who is another powerful voice in patient engagement and healthcare price transparency, I now know that the Robert Wood Johnson Foundation – one of the most respected research foundations in healthcare – also thinks that asking “how much is that?” is a critically important question in healthcare.

Here’s a video they posted a year ago. Still fresh today. Sing it with me: how much IS that? And start using the just-Symplur-registered Twitter hashtag #howmuchisthat to spread the word.

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