The Demand Side of Healthcare Reform

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

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

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?

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

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

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

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

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

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:

1. 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.
2. About 58 million non-elderly adults have at least one chronic condition.
3. About 65% of people with chronic diseases are working age adults.
4. Unfortunately, Americans with chronic conditions get the recommended care only 50% of the time and less than 50% have their disease satisfactorily controlled
5. 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

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