Healthcare: Managed Cost, Mangled Care - How-to Navigate the System

The Demand Side of Healthcare Reform

2009-09-30T08:11:00.003-05:00

I just couldn't help but respond to this video blog and resultant poll from Medscape. Dr. Henry Black talks about the "Demand Side of Healthcare" or when a patient sees an ad on TV or magazine, read on the internet, etc about a new test or treatment. They then come to their health professional with this information and "demand" to have this treatment, test or what have you. Since most physicians do not have the time or resources to continually explain why they do not need that test, they cave in and order it. Dr. Black believes this is another aspect that has contributed to increased healthcare costs. He further states that he had not heard this aspect addressed in the reform "talk". The subsequnt Medscape poll did demonstrate by and large the majority of healthcare professionals either strongly agree or somewhat agree that this is the case.

What was most interesting to me was that the physician group of voters had a higher percent of votes in the "Somewhat Agree" while other professionals had the highest percentage in the "Strongly Agree" voting pool. Is it a difference of those of us who are not physicians having a false perception of reality or the physicians unwilling to admit that they succumb to the pressure? Which case is correct is probably irrelevant since most all professionals agree this to be the case. From my perspective...I certainly believe that to be the case and have seen it happen for years. I do believe it has contributed to rising costs and could be included in part to the practice of defensive medicine.

I first recall this being an issue many years ago with the debate over doing a csection vs a vaginal delivery. It was thought at the time (and still today) that the increasing frequency of csection deliveries was due to consumer demand AND convenience for the physician and consumer. Afterall, when you can schedule the delivery of your baby there is much less interruption in your life...you can plan around it. The physician can also plan it at a more convenient time than in the middle of the night...why not? Of course, having a csection is a greater expense on resources (thus increased cost) and carries a greater risk of complications.

I could go on and on about the continuing debate related to "birthing a baby" but the point is greater than this one example. Throughout the years we have seen higher prescription orders for new drugs or newly "advertised" drugs...thought to be directly attributable to consumer demand after seeing the advertisements or before that, directly attributable to physician's responses to pharmaceutical reps visiting and gifting. It is a big game and we are all losing.

The point to all this is: until WE the consumer and WE the healthcare professionals agree and follow accepted standards of care, we will always be losing in this game. This has been partially addressed in the here-to-fore presented platforms for reform i.e. The Mayo Clinic Experience. For conditions in which we do not have evidence of the most cost effective and highest quality of care, we need to establish that evidence. For conditions in which we do have sufficient evidence for determining the best quality of care (and therefore most cost effective) we should use them. Staying informed and even questioning our physicians is our right and perhaps a responsibility. However, our relationship with our healthcare provider should be a partnership in which we discuss and agree upon the best treatment plan...we should not have to "demand" it...it should be a given. And just because we see it on TV, does not make it so.

This area should be elevated in scope as a major spoke in the healthcare reform wheel. It has been mentioned but not emphasized enough. I invite your comments, agreements and disagreements.

Medication: Get 2 for the Price of 1

2009-09-27T18:56:00.003-05:00

The following tip may be useful for some people with a portion of your medications. Let me first put out a disclaimer that to use this method, the individual must be mentally, physically and emotionally capable of carrying out the task correctly. Always use your physician's advice in the use of any of your medications. Having said this, let me describe this potential option. It may be applicable with some of the more expensive medications that are very limited in the amount that can be received in a month time. This is the case whether you have insurance or pay out of pocket for your meds.

Many medications can safely be cut in half. These medications are generally in a pill form rather than a capsule. Never try to half a capsule or a coated tablet...these pills are designed so that the effectiveness of the drug is dependent upon the particular coating of form. Ask your doctor if any of your medications are appropriate to try this method. Never reduce your prescribed medication dose without the advice of your physician, especially in order to save money.

To explain what I am trying to convey, I will use an example...Imitrex (a common pill used to abort migraine headaches). This medication comes in packets of 9 pills...you cannot get more in one month whether it is your insurance limiting it or the pharmacy. There is a reason for this...take too much and it can cause some very serious side effects. However, there may be times when you need to vary your dosage (as prescribed by your doctor).

Lets say that you typically take 50mg Imitrex at the onset of a headache and you need to refill your prescription every month or even 2 months. This drug is expensive (somewhere around $80), especially if you look at it from the point of only getting 9 pills at a time. Imitrex also comes in a 100mg dose (a packet of 9 pills, each one = 100mg). If you must vary your dosage, ask your Dr if it would be appropriate to prescribe the 100mg tablets for you. There are many considerations they may take in making that decision.
1. Are you capable to take the responsibility to divide the pills?
2. Are you capable to know how to take it?
3. Are they willing to take that chance?

This is not an uncommon practice. Some may say that it's fraud or it's just not doing the "right thing". I am not advocating fraudulently prescribing of medication. Based on your individual situation, this may be a very sensible solution. Your doctor will know if this option is appropriate for you. If so, you may not need to fill your prescription as frequently thus spending less money for your required dosing.

Ask your doctor if it is appropriate for your situation. Always follow your doctor's recommendations and never reduce your dosage or half your pills unless directed to do so.

Preventive Maintenance

2009-08-06T20:41:00.003-05:00

In a time when so many people are uninsured, partially insured and tightening our budget belts, it is more difficult for many to justify spending money for a physician visit when you are not ill. The problem with this issue is many serious health conditions can be festering inside our bodies only to erupt at a later time. When they do eventually begin to manifest in an outward way, the conditions could already have done damage that may not be reversible. Of course, there will be additional expenses to deal with these abnormalities.

Current patterns of health care utilization indicate a trend of people not using the healthcare system due to the state of financial uncertainty as well as other potential reasons. What are the consequences of this behavior? For the remainder of this discussion, we are going to assume that the previous frequency of health care utilization was for needed services and not just using the system because it was there, someone else was paying or you had a little more confidence in your individual financial situation. This is a rather large assumption and it is just that…an assumption.

What are the potential consequences of not changing the oil in your car or not maintaining the integrity of the roof on your house? The answer is pretty obvious…more serious problems that must be addressed or you may not have a car to drive or a roof over your head. And of course, it will be much more expensive than if you had just had the oil changed. I am talking about simple and inexpensive monitoring of your vital functioning. You can probably obtain the necessary care at no cost or a nominal fee.

The following items should be monitored on a regular basis and if one or more of them starts to change in an unfavorable direction, implement measures to correct or control. You have the power to control your baseline health. At a minimum, you should be monitoring and performing preventive maintenance of the following:
· Blood Pressure
· Cholesterol
· Blood Sugar
· Heart rate
· Breathing patterns
· Skin integrity

Your response in an effort to balance the above measures is an entire discussion for each one. There is a wealth of information at your finger tips to assist you in your effort.

How do you obtain the necessary monitoring and care?
1. If you have health insurance, check your policy for provision of “Preventive Health”. Many policies will cover these services with very little or no out of pocket expenses.
2. If you can’t afford these services, here are some options:
a. Check your blood pressure at the local grocery store or discount department store. Many of these businesses have machines available with no charge for the use. Look for them in the area of the pharmacy section. Check it at regular intervals and keep track of it in a log so you can see if a pattern develops.
b. Seek out community services. Most communities, employers or senior organizations will sponsor a “Health Fair”. Most of the time you can even obtain your cholesterol levels at no or little cost. Check your local newspaper, churches, hospitals, AARP or notices posted at your pharmacy or department store to locate these Health Fairs.
c. Often times in communities, free clinics may be offered. These often are sponsored by a healthcare organization (hospital, physician practice) or church. These clinics usually have physicians, nurses and sometimes dentists available. Search the same sources as mentioned previously.

So, you see there are options where you thought there were none. You might need to put a little effort into a search for these offerings, but it is well worth it. Maintain your physical systems like the well oiled machine that it is.

If anyone knows of additional sources or options, please comment so all the readers can benefit from your information. After all, that is what it is all about. Until next time…stay tuned.

Covering the Un-insured?

2009-07-21T21:49:00.004-05:00

It should be no surprise to anyone that a democratic bill, phased in over several years will reach the point of covering the uninsured in 2013. It will begin with collecting taxes on "the rich", banking the cash for pay-out in 2013. Can you spell Social Security?...Medicare?...bankrupt? Enough of the sarcasm for now. This is really a serious subject. What are people to do between now and 2013?? or longer?? We really can't expect things to change over night...the mess didn't develop over night.

There are some options within the current quagmire of health care. You may need to work around some things, through other things/providers and work WITH providers. I told a friend recently (who is uninsured) that if I could advise on 1 item, it would be to negotiate with healthcare providers (Doctors, hospitals, etc). However, you cannot expect it to be like the good doctor making a house call for a dozen eggs. But...this concept/strategy is worth a try. It will not be easy with negotiations because providers in this healthcare market are generally paid to provide more care (needed or not). The market will move toward an end in which this negotiation is more attractive. Just think...you could arrange with a physician to pay a certain amount (cash or services) for a visit, procedure, etc...at a discount of full price (of which is always over-priced). What is the incentive for the doctor? No paperwork, insurance forms, the time spent for billing, coding, re-billing. This, of course is only useful if you do pay your negotiated part and up-front.

Do you provide a service that could be useful to the provider? Plumbing, electric, drafting, cleaning, yeard work?? Perhaps, you could trade services. Think about other services that may be of potential use for bartering. Please share your thoughts and suggestions about this topic. Kind of an interesting way to approach your healthcare? Think about it...share with us.

Until next time... Simplify Your HealthCare with Alice@ezhealthcareonline.com

Gift For Women

2008-12-06T21:37:00.002-06:00

Great Gift for Women. It's not too late for guaranteed delivery in time for Christmas!

I have just received 200 copies of the most exciting book to hit the market in recent times. The book is published by Wake Up Women, a division of WakeUpLive... Wake Up has published a number of best-selling, team-authored books (paperback). To describe the format of the books I would say is similar to "Chicken Soup for the Soul". However, this long awaited book is written by Women for Women as a guide to enhance your life and truly Live a Life You Love. There are approximately 50 co-authors (women) from around the world, of which I am privileged to have been invited to participate. Each short story presents "golden nuggets" that you can immediately apply to your life...a little something for everyone.

I am offering a special for the holidays. Price is reduced. $14.00 including shipping.
You can start at my home page to direct you to the order pages www.EZHealthCareOnline.com or go directly to the order pages www.ezhealthcareonline.com/wakeupwomenbookandfreebonus

You have really got to check this out before it's too late!

"Know" Surprises with Health Insurance Plans-HMO

2008-11-21T23:07:00.005-06:00

Today, the discussion is related to HMOs. Today's HMO has evolved over the years. Referring back to my previous post, you will recall that there was a battle between providers and the insurance companies which greatly contributed to cost increases (in my opinion). The payment for services was largely uncontrolled. In other words, as the cost of care increased so did the payment. It didn't take too many years until the payers began an attempt to control how care was delivered in order to control costs. The HMO and Managed Care was born.

The HMO (Health Maintenance Organization) in it's most strict time, placed heavy restrictions on the setting for care (hospital, MD office, home) as well as the cost. The concept was that an exclusive network of care providers was created by payers. The providers would accept deep discounts on their reimbursement in exchange for guaranteed steering of patients to them. The impact on you is that you MUST use providers within that network or you pay a much higher price. Additionally, each person was to have assisgned a "Primary Care Physician" who was considered the gatekeeper for directing what care you did receive, i.e. referral to specialists, etc. The philosophy is that there would be one person/physician that would be in a position to keep the pieces of your care coordinated. Did it work?? For the sake of discussion, no it did not. The ultimate result was that there was too many services, too few primary (family) doctors and too many specialists.

Ultimately, the Managed Care concept met too much resistance to actually contain costs. The care was still passed around to specialists and there was not much actual coordination of care...just control of care. Over time, care became more fragmented as new technologies and treatments continued to attract people to multiple specialists and increased the costs. It has become "Managed Cost resulting in Mangled Care".

The HMO still exists today, but really the only thing that resembles the original HMO is the network of contracted providers. You must use those providers or pay a higher cost. A primary physician is usually no longer required...why would it be...it didn't work anyway. In fact, the HMO doesn't really look all that different from other popular types of coverage plans such a PPO (Preferred Provider Organization). The KEY for you is to read your policy carefully...some items will be covered and some will not and circumstances may dictate whether care is approved. Let's be clear...the payors are not dictating whether you can receive certain care but whether they will pay for the care. That's another set of posts. In the meantime, stay Healthy and Happy. alice@EZHealthCareOnline.com http://www.ezhealthcareonline.com/

"Know" Surprises with Health Insurance Plans

2008-11-16T21:38:00.009-06:00

I am going to discuss the different types of health insurance plans in the next few blog posts. If you have an employer sponsored health plan, there may be different options presented to you. If so, you really need to understand how they work so you can make the best selection for you. If you are purchasing individual insurance, it is really important to know what you are purchasing.

Today we are going to talk about the traditional "indemnity plan". This is what most people experienced in the early years of health insurance. Although it is not common to see this plan in today's healthcare market, it is good to understand how it works in order to help build the understanding of the evolution in health insurance. These plans are generally very simple. There is no restriction on the choice of doctor or hospital. For most encounters, you will pay a fixed percentage of the health bill. Common co-insurance (the part you pay) runs from 10% to 30% although it can be any number. Be sure you know what your co-insurance will be...a large bill could surprise you with a large part to pay.

On the other hand, the insurance company will pay either 90% or 70% respectively. While insurance companies have allways had contracts with health providers (as far as I know) to discount their services, the providers would increase their charges to off-set the discount. An example of this might look like this: a $500 dollar service would be discounted to $400. It would cost the insurance 80% ($320), cost you 20% ($80) and the provider collects the entire discounted $400. Then, so the provider can collect the total $500 for the same service the prices would be raised by 25%. The scenario then becomes 80% ($400) and 20% ($100) and the provider collects $500. Within these scnerios, note that your actual cost is higher. These scenarios have occured repeatedly through the years. The more the cost the more that the provider collected from you and the insurance company.

This cycle of increased pricing to off-set the insurance discounts, is in a big part the stimulus for creating other ways of negotiating and pay healthcare costs. That brings in the HMO and the term managed care. Refer back to the primary title of my blog as to how that played out. Our next discussion will be on HMO,

Keep Your Dollars in Your Pocket: Bargain With Your Doctor

2008-11-08T19:22:00.003-06:00

A recent WebMD article was listing ways to save money on your healthcare. The timing on this is excellent, since this has been our main discussion topic for several posts. The suggestion was given to bargain with your doctor. This is a topic I typically have on my list of suggestions also. When is this appropriate and how do you accomplish it? If you are going to be paying the entire cost of your visit, procedure or test, this is prime time to ask for a discount. The physician’s office will usually ask about your insurance as they are scheduling your first appointment. I recommend taking a very proactive and positive response to this question. Rather than just stating that you do not have insurance, tell them you will be paying cash. Explain your situation. WebMD suggests saying “You’re not in my network, but I wouldn’t trust anyone else to handle this. Is there any way you can adjust your fee for me?” You just might be surprised at what you hear. If you approach it carefully, develop a positive relationship with the physician and the staff, there is a high chance you will have a positive outcome. The physician (and hospitals or surgery centers) can adjust their fee for you and still come out with a larger payment than if you did have insurance (usually). If they believe that you will pay, it is more likely they will be willing to discuss it. It is fairly routine for a health provider to give a 20% discount. Most can go less than that and still make a nice profit. When they negotiate with an insurance company, there are steep discounts plus the member’s co-pay of only 20-30 dollars. So now you know that you have some room for negotiation but don’t try to force a steeper discount or you may get none. Remember, a good relationship with the health care provider is your best negotiating tool.

One last reminder. If you are negotiating with a facility (hospital, surgery center) do not pay your bill up front. You can save more money by examining the detailed bill. There are companies or people that can help you with that task. I can hook you up, give me a call. alice@EZHealthCareOnline.com www.EZHealthCareOnline.com

Keep Your Dollars in Your Pocket- Managing a Chronic Illness

2008-10-30T15:08:00.004-05:00

Save money on your healthcare by properly managing chronic conditions. Yes, I’m going to suggest that you actually spend some healthcare dollars. Let’s look at some statistics first:

More than 40% of Americans have one or more chronic conditions and people with chronic conditions account for 75% of healthcare spending in this country according to a recent study published in Health Affairs.
About 58 million non-elderly adults have at least one chronic condition.
About 65% of people with chronic diseases are working age adults.
Unfortunately, Americans with chronic conditions get the recommended care only 50% of the time and less than 50% have their disease satisfactorily controlled
Only 50% of those with chronic conditions take their prescribed medication, and the cost of poor medication adherence is more than $100 billion annually in the US.

Let’s talk about these numbers for a minute. 58 million Americans have at least one chronic condition and we are not, or choose not to receive the recommended treatment. We will talk more about that recommended treatment at another time, but once again, the medication issue has surfaced. Over $100 billion is WOW! A lot of money! I can’t really comprehend that amount of money. But, once again it is critical that we take our medications as prescribed.

Let’s use the example of Congestive Heart Failure. There are multiple specific interventions crucial to managing heart failure in a controlled manner. One of those interventions will likely be to take medications that will keep excess fluid from building (a diuretic) and a medication to help the workload your heart must endure. If you wait until you are short of breath to take your diuretic, it then increases the workload on your already failing heart. It will likely contribute to a needed trip to the doctor or worse to the hospital ER. Do you get my point? By spending the money to buy your diuretic and then take it as prescribed, you are reducing the likelihood of a more expensive intervention. An additional benefit is you feel better and can enjoy more of life. If you cannot afford to purchase your medication, refer to one of my previous posts on that topic.

I hope you choose to live life to the fullest and not let a chronic illness take you down. Most of the time, it is a conscious decision. Until next time, stay happy and healthy. You can contact me at alice@EZHealthCareOnline.com

Some are Stopping Their Medications Due to the Economic DownTurn

2008-10-24T13:05:00.003-05:00

A NY Times Headline reads: “Some Cut Back on Prescription Drugs in Sour Economy”. In the US, we have become a society of treating any ailment with a drug. A drug will fix anything. Consequently, the US is highest in the world on prescription drug spending which last year was estimated at nearly $286.5 billion. Now, for the first time in quite some time, people are trying to reduce the amount of prescription drugs utilized. The economic downturn has caused more people to choose between gasoline, food and medications.

I believe it is reasonable that expenses could be lowered by cutting out some medications…I don’t believe it should be undertaken lightly and certainly not without a joint plan with your physician. People are apparently stopping medications for high cholesterol, high blood pressure, etc. It seems to be primarily the drugs that do not produce a noticable affect such as that of pain pills. If you stop your pain pills you will feel bad therefore those will not likely be on your list to cut. If you stop your cholesterol medication, you probably don’t really notice a difference (at first).

Let’s talk about the consequences. Which is more cost effective: paying for the pill to keep your blood pressure under control or having a stroke, putting you in the hospital probably paralyzed, needing rehab and thus not being able to provide for your family or yourself. Sorry, but this is the harsh reality. If people stop taking the medications that are having a long-term benefit for your health, it will ultimately result in more severe illness and even higher medical expenses.

Below are my suggestions for approaching this dilemma:

1. Refer back to my previous post of ways to reduce the cost of your medications

2. Talk to your doctor about weaning from some of your medications

3. Many of the conditions being treated with pills can be controlled with diet and exercise. Examples are hypertension, diabetes (Type II) and high cholesterol.

4. DO NOT CHANGE YOUR PILLS WITHOUT TALKING TO YOUR DOCTOR!!!

5. Do not spread them out over a longer period or break them in half to take only half the prescribed treatment.

Please consider the longer term effects of your medications on yourself and your family. You do have options, please try them. Until next time, stay happy and healthy. alice@EZHealthCareOnline.com www.EZHealthCareOnline.com

Keep Your Dollars in Your Pocket (Part 2)

2008-10-24T13:00:00.001-05:00

In this post, we will discuss how to save healthcare costs on your medications. Since it is the medication costs that are usually the portion of your care that is most likely to be an ongoing expense, we will start there. Many times people with chronic conditions can be on 6 or more medications. Due to the costs, there are often times when there is a decision between purchasing medications and putting food on the table. I have seen it many times that the medications will not be taken, the condition becomes worse and the person ends up in the hospital.Only recently have we begun to see ways to save on your healthcare costs. Most of the literature that suggests ways to lower you medication costs, generally cover the topic fairly well. However, I do usually have one or two items to add.
1. Generic drugs: When your doctor gives you a prescription, always ask to be sure there is a generic equivalent available. These are the same chemical structure, only much cheaper. Most meds that have been on the market for a while will have a generic counterpart. Beware of new medications on the market, they will usually be very pricey and no generic will be available.
2. Home delivery: For medications taken regularly, you can usually access your health plan's pharmacy benefit in which it can be delivered right to your front door. Besides saving on gas to frequent your favorite drug store, you can usually get three months at a time. To make it easier to switch to home delivery, call your doctor's office and ask the fax a prescription directly to home delivery pharmacy. They can then be scheduled on a regular basis so you will no longer have to remember to order your refill.
3. Drug List: Each health plan will usually have a list of drugs that are categorized into groups of which designate how much you will pay or how much the health plan will cover. It may be a difference in co-payment or some will not be covered at all. Take the list with you to your doctor and make sure any medications ordered are in the best category for your benefit i.e. your lowest cost.
4. Non-prescription drugs: Many medications that were once only available by prescription are now available without. They are usually less expensive than the same kind of drug by prescription. An example is the heartburn drug Prilosec. When purchased with a prescription it costs about $116 per month. The cost of a similar amount of the over-the-counter version is about $25. Be sure and check with your doctor if this could work for you.
5: Samples: One of the big ways that drug companies advertise their new drugs is directly with the physicians. In most doctor offices, there are frequent visits from drug salesmen. Most of the time, they will leave samples so the doctor can "try the drug" to see if it serves the purpose. Really, it keeps their drug in “top-of-mind” for prescribing. In some doctor offices, I have seen extensive amounts of sample medication...actual sample closets. If the doctor gives you a new prescription and there is not a generic ask if they have samples. I have been able to get a patient’s entire set of medications from samples. Unfortunately, with the economic situation of the past few years, even the drug companies have felt the pinch so it is somewhat more difficult to obtain samples in that quantity.
6. Different Drug: One of the things I usually include in suggestions for cost savings is to ask if there is a different medication that will accomplish the same thing, but be less expensive. There are times when the physician may not think about the cost of the drug. They will order the latest and greatest, or the one that the drug salesman recently spoke with them about. Whatever the reason, it does happen. Always ask if there is a less expensive drug. You can also talk to your pharmacist about alternative medications. Then your doctor will need to change your prescription.Hopefully these have been helpful tips to help you reduce your healthcare costs. Until next time, stay happy and healthy.www.EZHealthCareOnline.com alice@ezhealthcareonline.com

Keep Your Dollars in Your Pocket (Part 1)

2008-10-24T12:54:00.003-05:00

As of late, there has been several articles addressing measures to reduce your healthcare costs. Recent health population studies indicate that our "senior" (>55) population is better equipped to do that than young adults (25-34). While 3 in 4 adults expressed concern about the cost of healthcare. What is ironic about the results of this study indicate that the seniors are more savvy at finding savings on healthcare costs than the young adults. Seventy percent of young adults stated that the economy has made it significantly harder to pay for healthcare expenses. Here's the kicker...more than half of those >55 stated the economic downturn had not impacted the ability to pay for healthcare at all. This is the opposite of what most people would have thought. It seems that the seniors are more experienced at reducing their costs.
The most prominate area of expense is with medication costs. The study indicated that while those <35 are in fact looking for ways to cut their medication costs but 1 in 5 say they do not know where to start. Only 3% of those over 55 answered the same.
In short, it appears there is an apathetic view of healthcare cost pervading the population...people either don't know where to start or simply feel it is a futile effort.
Well...let me tell you, it is not a futile effort! There are ways to cut your costs and streamline your care. Over the next few posts, I will be discussing some of those methods. Until then, stay healthy and happy.

Can You Obtain Health Insurance?

2008-10-09T20:15:00.007-05:00

As statistics continue to indicate the increasing numbers of uninsured in the US, it is (or should be) of utmost concern to every American that the team we elect into the presidency as of January has a firm plan to reform health care. In my opinion, the health care system is in a state of turmoil akin to the economic crisis. They are going to go hand-in-hand. Today, WebMD published articles related to the uninsured which did reinforce what we have been told all along of the number of uninsured. Along with these statistics, a recent study by Consumer Reports was highlighted that indicated it has become increasingly more difficult for individuals to obtain insurance coverage.

Here's the link to the article: http://www.webmd.com/news/20071203/buying-health-insurance-on-your-own

In other words, if they do not have group coverage through the employer, it is difficult or near impossible to obtain it unless you are completely healthy. They told the story of a woman with Rheumatoid arthritis who lost her group insurance when her employer discontinued the plan. With her arthritis, the only thing that was keeping her from being completely disabled was a monthly injection of a medication costing $1400-$1700 per month. She has been turned down for most policy coverage or when accepted, it was to exclude any costs related to the rheumatoid arthritis.

I restate parts of the story to make a point. This situation is not an isolated one. I am fairly sure if I lost my group coverage, I would not be able to obtain coverage, or at least not anything I consider comprehensive and or affordable. In the above situation, she is actually considering not taking her injections (because of cost) until she is completely disabled again, then file for disability through the government systems. Now, is this what we want or need in a health care system? I think not, but it is not the fault of the insurance companies. I believe the insurance situation is a by-product of ever increasing costs of technology, drug research and development as well as the increase in the human life span. The attached link is to another article published on WebMD of items to consider and look for if you find yourself in the position of searching for health policy coverage.

It is extremely important that we demand of our legislators and the upcoming President of the US to implement a plan that will ensure every American is able to obtain health coverage regardless of current health conditions. We need to hold them responsible to first, implement a committee of health personnel and non-health care persons to identify what we actually do expect from our health care system. Then, do whatever it takes to find funding that will provide at least that basic requirement for every American. Now, I don't mean to imply that there is no personal financial responsibility.

As you can see, I am somewhat passionate about this topic. Due to that passion, I have provided some helpful resources on my web site (http://www.ezhealthcareonline.com/ ). I would also like to recommend a book recently published by a colleague. The book is "Healing Health Care" by Dr. Roger Howe. His analysis does give an interesting perspective of approaching a solution to this crisis...and yes, it is a crisis. That is my opinion.

National Case Management Week

2008-10-06T10:24:00.002-05:00

It is National Case Management Week. EZHealthCare wants to acknowledge all the Case Managers in the various areas of care provision. We see and use Case Managers in virtually every aspect of the health care system. We see them in Acute Care Hospitals, Long term care facilities, home health services, physician offices as well as Rehab facilities. They can be found in clinics, managed care organizations (health insurance companies) and even on the internet. My entire web site and business is based on a community based case management model. In this sense, I can function as your case manager.

The Case Managers are the ones who act as a central point of care coordination along with your physician. In cases where your primary physician cannot or does not act as a central coordination the Case Manager can assist in this manner. The basis of Case Management is to “manage” the case/care…your case. This does not mean we provide hands-on-care for your illnesses…your doctor should do that. We can assist you in pulling the different pieces of the healthcare puzzle together. This helps eliminate gaps in care, duplication in care by more than one physician and to help you understand your conditions to better self-manage. This is usually a Case Manager’s goal with you…to assist you to become more independent with your care and that includes providing education and resources. There are times when you may need the services of a case manager for a prolonged or extended amount of time.

My services at EZHealthCare include that of Community Based Case Management. If you would like to know more about how I can help YOU, please contact me at alice@EZHealthCareOnline.com or check my web site: www.EZHealthCareOnline.com

Maintain Care Information Flow

2008-10-04T19:16:00.004-05:00

Let's talk about coordination of care. In the last post, I mentioned how your primary care physician (PCP) is the one who serves as the central point of coordination for your care. He/she should have any information from specialist visits and from any testing that may have been ordered by another doctor. You have a role in maintaining this flow of information. One opportunity for this occurs when you have a test such as a CT scan or a x-ray ordered by another physician. The ordering physician is the one who will receive the report findings of the test. At the time you are providing your history and giving consent for the ordered procedure, there will be a place on the forms asking if the test results should be sent to any other physicians. This is your opportunity and responsibility to facilitate the flow of information to your PCP. Always add your PCP to this list of recipients assuring that not only the specialist will get the results but also to your central point of coordination. By doing this consistently, your doctor has the ability and information to adequately identify any patterns that may need to be addressed.

Your consciousness of this is more important now than ever in the past. Most insurance plans today do not require a referral from a PCP for a specialist visit. All you need to do is make an appointment. If the specialist does not include your PCP with the findings of the examination and any tests, your PCP may never know of the specialist visit. There will be a gap in information and potentially in care. Ask the specialist to send a copy of the assessment and findings to your PCP. You may want to ask for a copy also. The days of the patient not being knowledgeable of the doctor's records are gone. You can then make sure your PCP does indeed have copies of your information.

Another area that needs your action to assure information flow is with your preventive care tests. An example is a mammogram. There is often no need for a physician referral for a yearly screening mammogram. If you do not identify the physicians to receive a report, your PCP may never know you had it done. Consider this aspect of your coordination of care any time you have a health care experience. You can always check with alice@ezhealthcareonline.com if you need assistance with any aspect of care flow.

Do You Need a Family Doctor?

2008-10-01T19:41:00.003-05:00

I read an article yesterday advocating for Family Practice Physicians as a critical piece of the healthcare reform puzzle. I happen to agree. We all need a central coordination point for our healthcare. In the medical community, this is known as the "Medical Home". Your family practice doctor, also called primary care physician should be the one you see first for any condition, and more importantly for preventive care. Your physician is not to be seen only when you become ill. One of the main issues with today's healthcare system is that it is fragmented. We see a specialist for every different illness we have. In this case, you are the only central point of coordination, potentially leaving gaps in care or missed issues. The family physician needs to evaluate your conditions, assure you are being cared for according to national practice standards and make referrals IF necessary. All information obtained through a specialist referral should be channeled back to your primary care physician. This assures someone has "The Big Picture" of your care and can put together the puzzle.

Health Insurance Application

2008-09-28T20:21:00.003-05:00

Hi everyone. It is time to get this blog up and going again. The first thing I want to tell you about is completing a health insurance application. If you are applying for coverage, most likely, you will need to provide a health history. It is of utmost importance that you include absolutely everything. They will likely ask for a complete history for the past 3 years, maybe 5 years. Include all medications, Dr. visits and any health conditions or injuries. It is very difficult to remember every little thing, but that is what you will need to do. If you don't include everything, and it surfaces at a later time, it could result in non-coverage or even rescinding your policy for non-disclosure.

No one wants that to happen, but that is how it works. My suggestion to you is to start a list now. Do this even if you don't think you will not need it. Going to a new physician, you will need to answer these type requests. Start your list now and every time something changes, update your list. Make a list of any medications you are taking or have taken in the past five years. Include even an antibiotic or sinus pill. Add the reason for taking each and the approximate dates. Do the same thing with any illnesses you may have or have had and any visits to a doctor.

Being proactive in keeping a personal health record now, will save you time and accuracy in the future. This gives you time to account for everything. As you remember something, add it to your log. Do this, and you will be prepared for the next time you are required to submit health information. You will find examples of blank logs on my web site: www.EZHealthCareOnline.com

Increased Incidence of Two Cancer Types

2008-07-20T18:26:00.007-05:00

Hi Guys!

I want to make everyone aware of some new statistics. It is not the most pleasant topic, but it is necessary. Cancer. The other day I discovered these statistics by the Americal Cancer Society. As we have all been shown many times before, the leading cancer for women is Breast Cancer and for men is Prostate cancer. Due to early detection and improved treatment, the incidence is decreasing. In other words, new cases of these cancers have decreased. However, for both men and women a leading type of cancer is colorectal cancer. I think it is very important to note various prevention and early detection procedures. An example of this is regular self-breast exam and yearly mammogram. In men it is a PSA blood test and rectal exam to check the prostate. These methods have decreased the incidence and mortality rate due to early detection. For early detection of colorectal cancer are checks for blood in the stool and a periodic colonoscopy.

A main point was made with both these charts is the fact that:

About 33% of the 559,650 estimated cancer deaths for 2007 are related to

being over weight or obese
physical inactivity or
poor nutritian

Now, please look at the charts I have provided through this link to my web site. Obviously, preventive care is of ultimate importance.

http://www.ezhealthcareonline.com-a.googlepages.com/cancerstatistics

Thank you for visiting and I hope to see you again.
Alice

Do You Have Chronic Back Pain?

2008-04-13T21:34:00.005-05:00

Good Evening Everyone,

I have back from a little time off. I've got a lot of stuff to share so I will get right to it.

If you have chronic back pain or muscle weakness, it may be caused by something you never would have thought...a lack of VitaminD. Yes, that's correct. A vitaminD deficiency. According to the authors of this article, we in the United States have contributed to this. There are many problems that can be a result of the lack of this vitamin. For one, in order for calcium to be absorbed for maintaining bone strength. This deficiency has been attributed to increase risk for several cancers...colon, breast, prostate, lung and skin cancers. It sould be easy to correct since the sun light is the main source of VitaminD. Since we have gone nuts to prevent any little piece of sun to hit our skin for fear of skin cancer we do not get the good and healthful aspects of the sun. The article mentions some studies that indicate the greatest risk for skin cancer seems to be fair colored skin. Of course, if we get many sunburns throughout our life, it can increase the risk.

Any way, I found this article to be very eye-opening because my physician has just identified that I have a deficiency. She has me on a gel capsule one time per week then to re-check in 3 months. The main thing that they seem to worry about is the lack of calcium absorption which will lead to brittle bones. I sure don't want that! But, I am interested in potential improvement in my achey and weak muscles and the low back pain. I don't think physicians are aware enough about other symptoms of VitaminD deficiency...We need to spread the word! The article gives information on home testing kits.
http://www.naturalnews.com/022997.html

I will keep you posted about my results!
I will also make available some a link to the article as well as other healthcare tips.

Alice

Simplify Your Doctor Visits, Part 2

2008-01-25T14:31:00.000-06:00

As I stated in the previous post, I will give you some helpful steps to ensure adequate information exchange. I'm sure you all have experienced this scenario: You schedule an appointment, You then must wait in the waiting room, many times longer than you think is necessary, filling out endless forms, only to finally get in and spend about 3 minutes with the doctor...you had questions but with the rush, you could't remember what to ask. I am going to tell you the same thing as in the previous post: Write it down!!! You must obtain adequate information in order to manage your healthcare! In today's world, you need to educate yourself about your healthcare, be involved and take charge.

Write it down:
In addition to your questions also document your health history, it will help you in establishing a baseline for your new doctor. Below are suggested items to include in your list of questions:

Document all your health conditions, when that condition developed and ended (if applicable), what type of treatment you have received and whether it is ongoing. This is a critical step to go with the medication list.
Create a list to take with you to the doctor visit; write down all your questions, concerns, etc. In a subsequent post I will list several items that are critical to know in order to to adequately manage your healthcare.
Take the list with you to the appointment (make a copy before you come).
Depending on your condition, etc. may determine how to get your questions answered. If there are only a few questions, you may be able to ask them while you are with the doctor.
Usually, your best action it to tell the nurse that brought you in that you have several questions for the doctor.
Many times you can give the nurse the list and they will present it to the doctor prior to entering the room. This gives the doctor enough time to realize that he/she will need to spend a little more time. Additionally, they may be able to answer some of them prior to entering the exam room.
You can use the information provided to search the internet for additional info.
Keep up with that list of questions and answers so you can compare over time...at some point you may need to refer to it.

Eight steps to an efficient doctor's appointment. Of course, this would also be applicable for other types of healthcare professionals, for example Physical therapy, chiropractor, any of your specialists.

Once again, I have placed a template on my web site for your reference. www.ezhealthcareonline.com

I hope this helps you in some way. I know it has definitely helped me! Thanks for your time.

Alice

11 Steps to a Productive Doctor Visit

2008-01-25T13:34:00.000-06:00

Well, I'm back. Today I am going to tell you some secrets that will help your Doctor visits be more productive. Every time you go to your Doctor, it is usually difficult to get the exchange of adequate information you want or need in order to manage your health at optimum...has that happened to you? I know I have experienced this. I recently changed insurance plans due to a new employer, so I was forced to select different physicians since some of my previous doctors are not in the new plan. This was very troublesome for me since I have had the same Primary Care Physician for 28 years. During the first visit and periodically from there, they will ask for an update on your health information. I found myself repeating my health information multiple times...and if you are taking several medications it is vital that you inform them of all your medications. Can you remember all the specifics regarding each of your medications? I seem to always forget part of it if I am going from memory.

Here is my solution to both issues: Write it Down and keep it updated. Easy, right? Well, it does take some time on the front end, but saves you time on the backend. Let's start with your medication list...if your doctor is not completely informed about your current medications and your allergies, he could easily prescribe something that is not compatible with one or more current medications.

Gather every medication you have, even any over the counter meds such as Advil, Prilosec, sinus pills, etc)
Also count any herbal supplements.
Sort them based on the reason you are taking them...if you are going to include meds you are not currently taking, be sure to note that.
Write down all the information for each medication.
Name of Drug - common name and generic name if applicable.
Dosage of Drug - for example: 20 mg or 50mg.
The route taken - by mouth or injection (for example: Insulin, injected)
Reason you are taking this medication...this is very important!
When was it first initiated?
Include the ones that you just take periodically as needed, but be sure and state that on your record.
Record all your allergies...even if it is just hay fever.

There you go. Eleven Steps to a Productive Doctor Visit, Part 1. I will place a log on my site that you can retrieve if you want to use it. That site is www.ezhealthcareonline.com

The next post will deal with communication with your doctor...be sure and tune in!

Alice

Medication Costs will Break the Budget of Retiree’s Nest Egg

2007-11-16T16:09:00.000-06:00

This is a VERY IMPORTANT post!!!

We have all heard about how Drug Costs are increasingly becoming a burden on our pocket books and the Healthcare System as a whole. For those of you planning for retirement, you would be wise to factor in general healthcare as well as medication costs. A recent study conducted for MedCo a pharmaceutical benefit manager, indicates that one in three retirees claim they are spending far more on their healthcare and prescriptions than they expected. The research indicates that for one in four middle-income retirees, $1 out of every $10 of their monthly retirement income goes to pay for medications alone. The average 65-year-old couple retiring today will need $70,000 just to cover Prescription drug costs. Twenty four percent claim to use very few to none of the cost savings tools available to cut their medication expenses. Now, more than ever, retirees are nervous about outliving their ability to afford the escalating costs of living well.

Medco is making it their purpose to educate retirees about tools to unlock hidden savings that can be used to reduce their prescription drug expenditures. Here are a few more figures revealed in the study:

Nearly half of retirees stated they infrequently or never discuss with their Doctor ways to save money on their medications, such a switch to generic medications rather than name brand.
Few knew about Drug Optimization: taking fewer pills at a higher dose to reduce the number of pills you have to buy…always work this out with your MD and pharmacist.
40% of Seniors who have reviewed Medicare plans indicated that their primary factor in choosing a plan is premium price.
One in five seniors over age 65 who are still working stated one of the reasons they continue to work is to receive employer-sponsored drug coverage.

Medco then offered six (6) tools or strategies that can help reduce the out of pocket costs of medications. These tools are briefly described below. I will put the entire study as a page on my website with the link as shown below as well as my email address if you want to talk it through with me. I will assist as I can.
Save money by using a mail-order pharmacy for all your maintenance medications. Average annual savings with Generic through mail order equal $396…..THAT IS SIGNIFICANT SAVINGS!!
In choosing a Medicare Part D Plan, look at more than just the premium price. An excessively lower premium price may indicate higher out of pocket costs and plan restrictions. Other important factors you should consider when evaluating the value of Medicare Part D plans:
-Out-of-pocket costs: what are the fixed co-pays and co-insurance.
-Size of the formulary (how many drugs the plan covers)…are your drugs covered under the plan??
-Coverage in the “donut hole”…Does it cover costs in the Coverage Gap between $2,510 and $4,050? There are tools on the internet that allow you to plug in your meds and estimate cost.

www.medicare.gov www.medicaredadvisor.net

Ask your Doctor if there is a generic alternative for your drug. Most physicians will be more than willing to write for a generic med. However, if you do not ask, many times the physician writes for a name brand drug. In my opinion, the reason for this is 1) it is easier and 2) the pharmaceutical sales people are continuously marketing to physicians for the use of their name brand drug. They leave samples which also contribute to continuing on with the name brand. The total cost of a generic drug can be up to 80% less than its brand name counterpart.
Ask your doctor if your medication dosage can be optimized. For instance, you take your blood pressure med 20mg twice daily…that causes you to buy 60 pills per month. If you can take twice the dose (40mg) one time daily, you would only need to purchase 30 pills. Another way to do this is to prescribe the larger dose but you break them in half to continue taking them twice daily. This can amount to over $500 per year. A word of caution: DO NOT do this without arranging it with your doctor!
Learn the secrets to online savings. Probably the main disadvantage here is that many sites provide comparisons based on retail price…the price someone what is uninsured or are paying 100% for the bill. Otherwise, look for a plan that has an online comparison tool that compares prices based on your individual plan, not just retail prices. Many times the company web site will offer this tool…Use It!!! A recent study found people who switched to a lower-cost drug after using a prescription benefit provider’s cost-comparison tool saved $171 annually per medication.
For those who see more than one doctor, including specialists are now taking many different medications. Each doctor may not know all the medications you are taking, how much and when. Here are two ways you can be wasting money (aside from the effects on your health) if you don’t tell your doctors about all your medications.
o Medication Duplication – two doctors prescribe a medication that does essentially the same thing as others you are taking.
o Medication Cancellation – Two doctors each prescribe a medication that cancels the other out.

Either way, you end up paying for medications that aren’t working the way they were intended. Since this is more than a cost saving measure, it could be a life-saving measure you must inform each of your doctors of all medications you are taking…this included over the counter meds and herbal supplements. The best way I have found to make sure you don’t leave anything out is to put them in writing and take the list with you when you present for any medical or mental health care. I will also provide a sample medication list on my site.

I think I have provided you with some pretty significant possibilities for major cost savings with your prescription plans. It is the time of year to be shopping for your 2008 plans. Be sure and consider the above suggestions to provide the most cost effective plan. If I can be of any assistance, my email address is

Email : ezhealthcare@sbcglobal.net

Web site: http://www.ezhealthcareonline.com

Health Insurance: To Buy or Not to Buy? That is the question

2007-11-06T16:20:00.000-06:00

Hi everyone!
I am back to continue our discussions.
Many of us are fortunate enough to have employers who provide a significant portion of our health insurance coverage. Today I am very grateful for that but that has not always been the case. I need to tell a story. Being a nurse, my employment options have always been fairly solid, i.e. among other things my Health Insurance policy has always been provided with very little out of pocket expense. Not to long ago I was transitioning out of one job/employer with the intent to take a break and “find myself”. My little break meant I would be paying my own health insurance. I could not believe how much it cost! This was just for myself (but it was very good coverage)…I really couldn’t even guess what it might have cost if it was a family policy…Oh My Gosh! So, I am paying my way and there is no income…you can imagine this might not last very long. I also ran up some additional expenses. Suddenly I ran out of money and didn’t have another job lined up at the moment. I depleted my entire savings, had an excessive amount of revolving debt and had More Out-Go than In-Come. I was riding a very thin financial line.

All this story to say that at that point, if a large expense occurred I would have absolutely no resources to manage. I could easily see how the middle management, middle aged person can end up sleeping in a cardboard box down by the river. I was very fortunate to be able to secure another position (one that is right for me) that provided benefits. I managed to get my revolving (credit cards) debt down while I checked on other options. I could see the abyss and it was scary. I can now see how people could let themselves be without insurance. Similar decisions as to whether to take the dog in for her yearly vaccinations or pay the electric bill are somewhat common at my house these days.

Now, we can finally get to the question of can you go without insurance??? My opinion is a big fat NO!

What do you guys think about this topic? Let me hear from you. I will return later and continue...unless you guys give me something else to talk about.

Alice

Staph Infections (MRSA): What You Do to Prevent Them

2007-11-05T09:10:00.000-06:00

Hi All!

I saw another article regarding this topic so I thought I might as well weigh in on it. There is a lot of talk about MRSA infections or antibiotic resistant staph infection. This is sometimes referred to as a Super Bug. There are only a couple of antibiotics that will kill it and those are pretty powerful drugs. So, how did it get to this point? You know that the bacteria Staphylococcus Aureus is present on our bodies and many times in our nose. In fact, one source says that the nose is the most common for it to hide and the place we really need to watch out for. It is a mutation of this Staph Aureus bacteria that becomes antibiotic resistant. Over the years, when we were sick, we would most likely be prescribed an antibiotic. The bug gradually became resistant to them. Additionally, as people have illnesses that lower the immune response (for example HIV, chemotherapy, etc.) the bugs spread and gradually became resistant.

Still, the hospital is the most common place this appears...close contact, multiple other illness, etc. I have always heard the phrase: "The hospital is no place for sick people". Meaning that there is a mixture of everything and someone with a lowered immune system predispose you to infection. If you do not NEED to be in the hospital, try to get your care at home. Now, I am not trying to say that hospitals are dirty or anything as such but there is too much of it floating around.

If you are in the hospital, there are a few things you can do to minimize your risk of infection:

There should always be a dispenser of antibacterial solution, usually mounted on the wall. Any time you are up, to the bathroom or touching things, blow your nose, cough into your hand, etc. you should use the solution on your hands.
Make sure that every care giver (nurses, physicians, therapists, transport, etc.) use the solution prior to touching you. Sometimes the physicians are not cleaning their hands, but if you think about it they go from room to room and could easily spread an infection.
Also watch the instruments that care givers use...are blood pressure cuffs moved from room to room? Asked that it be cleaned prior to your use.

Becoming more and more common is the Community Acquired MRSA. Contributors are rampant use of antibiotics. This bug as said previously is in your nose, on your skin and in the dirt. Other common places are the gym, hot tub, crowded living areas, contact with other people such as in prisons, the gym. Poor hygiene contributes to the infection. Below are some steps you can take to help prevent contamination:

Bathe regularly-the bacteria is on your skin, but can be washed away with good hygiene. Be sure to wash the areas that are usually warm and moist - under arms, groin area
Wash your hands frequently
Don't pick your nose! After blowing, always wash your hands.
If you have a cut or scrape, cover it with a bandage until healed.
If you are given antibiotics for anything, always take all that is prescribed. Being careless with antibiotics has led to several resistant strains of bacteria. More often now we are seeing a change in ordering antibiotics unless really needed. Infected cuts/scrapes are usually treated conservatively without antibiotics and if it starts getting worse then they will break out the drugs.
Don't share towels, clean gym bag and don't put dirty clothes and towels in gym bag--the warm moist environment is a feeding ground for germs.

I hope this has helped give you some practical knowledge you can use anywhere. Stay clean and don't pick your nose, until next time.

Alice

Factors Influencing our Choice of Doctor or Hospital

2007-11-04T22:40:00.000-06:00

I am back again to continue our discussion on pricing / cost and free choice in determining our Doctor or Hospital. Since we introduced the concept of how (sort of) prices are determined and we all know that they are too high, what about health insurance? Do we really need it? and this next question is a big one...is it or should it be our right to obtain health care rather than a choice...should the US Government make a national healthcare plan to provide care to everyone from cradle to grave? This will be a hot topic for the presidential election...Hillary is already talking about it!!!

Oh my! Where to start? Do we really need health insurance? Will we not receive the same care if we do not have insurance? The answer to that is very tricky. A hospital (if they receive any federal money) cannot turn away anyone with emergent illness based on the ability to pay...this is part of what are referred to as EMTALA laws. They were the product of the 1997 Social Security Act. which also yielded the privacy laws. But let me tell you, there are a lot of caveats. These laws are watched pretty closely...especially by competing hospitals in a community. For instance, a person presented to Hospital A with a cough. He was not admitted so he goes down the street to the emergency room where it is determined he has pneumonia and is admitted to the hospital. He does not have insurance and mentions to Hospital B staff that he was at Hospital A earlier. This could trigger Hospital B to either make a call to A and check it out or a call to the hospital police to be investigated. If a hospital is deemed that they broke the rule...they could actually lose their federal funding. Losing Federal Funding would for most facilities put them out of business. Federal Funding can sometimes account for more that 50% of their revenue.
In addition, most facilities have policies stating that you will not be turned away based on the ability to pay.

So, now! Do you really need health insurance anyway? Especially if the employer is not paying the premium cost.
You guys ponder that for awhile, and I will check back with you later. Bye for now.

Alice

our Right to Free Choice of Doctor or Hospital

2007-11-03T17:28:00.000-05:00

Hi Everyone,

What did you think about the pricing discussion?

I think most people will agree that this is a big issue in healthcare. A big issue for providers as well as you and me. It seems like prices for healthcare services just keep going up. We cannot get a break. The worse part is that they have a captured audience when we seek healthcare. And some providers may take advantage of that by raising prices on services we need, then of all things...make us pay for it.

Anytime another rule or initiative that is aimed at enhancing quality of care comes about, you can bet the cost is going to go up. So, how do we manage to get the needed healthcare and pay for it also. You know, this is a free society and what something is worth is deemed by how much someone will pay for it. But of course, a business cannot price itself out of the market. If there are three hospitals in a community, they will vary somewhat in their services, outreach and prices. Rest assured that before they raise any price, they have surveyed the market to see what is reasonable and comparable.

So, I have just decribed the global view pricing...so if all the prices are comparable (physician and facilities) what differentiates one from another. How do you decide who or where to get your care...OR do you even have a choice? Ya'll think about that for a little while...I will be back later to finish this discussion---It is going to get good! I will spill more secrets in order to assist you.

Until Next Time, Alice

Health Care Cost: Hospital and Physician

2007-11-03T16:02:00.000-05:00

Hi everyone!

Now, I want to go back to the thought that Healthcare is a multi-billion dollar business. You know, if you think of it as a business it sort of takes on another dimension. A service and materials are provided then a bill that includes parts and labor is sent to you. This is no different than any other business. It may first go through your health insurance company to pay a contracted amount. Finally, the balance is billed to you. Once again, your insurance company may have contracts with you that limit the portion of that remaining balance that you will ultimately need to pay. I know it always seems like a large bill........... because it is!!!
You know...the $2.00 aspirin. As someone who has aspirin in the cabinet where the entire bottle was two dollars it doesn't make sense! But if you think about it like a business, the cost of that aspirin is partially labor, pretty much all of it. It includes the pharmacist, a pharmacy tech, transport to the appropriate place and then Nurse who gives it to the patient...but WAIT!! There are two of them, so it will be $4.00. Items or services that are larger in scope and higher cost will be marked up maybe less than the "aspirin". Most providers I have had experience with have some sort of algorithm for the purpose of pricing.

Now------- Hospital / Doctor Pricing:

What do ya'll think about it? Post a comment to this blog.

Until next time, Alice

ps: Next time we will talk about Health Insurance options and"sould you have health insurance"?

Medicare Stops Paying for Errors: Your Opinion?

2007-11-03T15:48:00.000-05:00

Well Hi everyone!

So what do you think about the previous post? Is this something that will reform the healthcare system? Or is it going to be an aggravator and not help at all? In the big scheme of things or at your personal level.

OK! What do you think? Let me know.

I think it is a mole hill that's just puffing smoke up our...nose. My guess is there will not be big savings from this measure. It will just create more paperwork and in general raise the cost to the rest of us--that's right--we will ultimately pay the bill. Providers (hospital or doctor) will need to compensate some how. To do this they raise the prices for those of us who will actually be paying a bill. Oops! That might have been a secret...oh well. But really...that is how business operates and we cannot forget that healthcare is a multibillion dollar business.

I will let you ponder this for a while, then I will be back.

Alice

Medicare Won't Pay for Mistakes??

2007-11-03T15:03:00.000-05:00

The thing that you will learn about me is that I generally will have an opinion about something. That opinion is not always the most popular and or it may be somewhat twisted. Any and all statements are my opinion and not those of any other party. Throughout my blog, you will find tips and techniques that will help you access and maneuver the system easily. The nature of the healthcare system creates many obstacles or bumps that make it difficult to work through.

A short while ago, there was an article in our local newspaper about how Medicare will no longer pay for mistakes. The general message was that hospital payments will be reduced or retracted by Medicare if the hospital charges were caused by a preventable hospital error i.e. certain infections or bed sores. I can just imagine that hospitals are scrambling to adjust for this rule. How will it be determined what is normal condition of a patient or a potentially preventable condition. I suspect there will be a fine line, resulting in conflicts between the hospital and Medicare. Appeals to the decision will be made and probably so much red tape to wade through that the cost of care has already gone up.

What is Medicare? It is the government's pay system for the elderly and disabled. The proportion of the population that is of medicare age is somewhere in the neighborhood of 50%. As we have all been warned that figure is going to jump drastically as the first of us Boomers turns 65 years old. So, you can think of Medicare as your future insurance company.
Something is fundamentally wrong with this initiative as with many of Medicare iniatives. That is leaving out the physician in the picture. Yes, there will be impact on the physician but it will be done by the hospital. It does not appear to me that this initiative is any different. The physician reimbursement is not affected by these restrictions. When this happens, the hospital is forced with implementing new policies and trying to convince the physician to not only comply but be enthusiastic about it.

I know it sounds like I am taking sides with the hospital industry but really I am more in favor of including the physician reimbursement with these cuts. I have always thought that the physician payments should be ammended along with the hospital...how else are incentives ever going to be totally aligned for the good of the patient-you and me.