The Health Shopper

A good suggestion from the New York Times: Call your doctor's office for your test results. The Times cites a study published in the journal Quality and Safety in Health Care that finds that errors occurs in about one in four lab tests, and in 7 percent of tests, or about one out of 14 cases, doctors and labs fail to notify patients of their test results. Although many patients assume that no news is good news, that isn't necessarily the case. Many of the patients who didn't get their test results-approximately 75 percent of them-had to pay more, suffered from poorer health, or were otherwise adversely affected by not receiving their test results.  So call your doctor.

A study by Katzenbach Partners finds that customer service in the health care industry lags behind service in most other industries. According to the study, 26 percent of respondents had switched or thought about changing doctors due to an unpleasant experience, and nearly as many have used or thought about using retail clinics to avoid doctors and hospitals. Two in five said that banks provide better service than health providers, while one in five said that airlines provide better service.

According to Katzenbach's researchers, poor customer service impacts care quality and cost by causing consumers to shop around for doctors unnecessarily-leading to different doctors to duplicate tests. Consumers who do not trust doctors may be less likely to seek out treatment when necessary or understand and comply with follow up care instructions.

Fast Company has a long, interesting story about how health consumers can save money through medical tourism. According to the article, as many as 500,000 Americans traveled abroad to save money on medical care last year to hospitals where treatments cost as little as one tenth of the American price. As one person quoted in the story notes, for many consumers, ""Your options are paying $50,000 to $60,000 in the States or coming here and paying $8,000… That's the difference between putting it on your credit card or going into bankruptcy." The story also notes that a recent McKinsey study estimates that up to 20 percent of hospital visits in the U.S. could be safely outsourced-which could help save the health care system $390 billion.

The New York Times has an interesting article on some of the challenges that early retirees face in finding health insurance. The article notes that for most people-especially those with no existing medical concerns-"the best, least-expensive option is to buy an individual policy" rather than opt into COBRA coverage through an employer. The story focuses on a couple in their early 60s who decided to leave their jobs before they were eligible for Medicare who were able to find an individual insurance policy for about $400 a month, which was about half the cost of paying for COBRA coverage. The couple did, however, have to spend some time shopping around due to some minor pre-existing medical conditions.

The article also offers another key point for early retirees: When leaving a job, individuals have 60 days to start COBRA coverage-that is, opt to pay to remain on an employer's plan-or else lose the option. As the Times notes, many early retirees may want to opt into COBRA initially until they have found coverage elsewhere.

California's Department of Managed Health Care has proposed rules that would prevent physicians from billing patients for additional charges beyond the costs of in-network care covered by insurance. Typically, billing disputes arise when patients go to in-network hospitals or emergency rooms for treatment but are inadvertently treated by an out-of-network physician who has not accepted the HMO's negotiated price. Physicians, in a process called balanced billing, can then directly bill the patient for the difference between the two fees.

According to the Los Angeles Times the department has been trying to work out a compromise between physician groups and HMOs on the issue for two years, but ultimately has proposed the rules to protect consumers from increased out-of-pocket spending. Under the proposal, consumers would not have to pay for any difference in billing. Instead, physician groups and insurance companies would have to resolve the disputes on their own.

A couple months ago, we noted that Fair Issac has partnered with Tenet Hospitals and other partners to develop a medical credit score. Today's Wall Street Journal examines the trend of hospitals examining patient finances after billing, which has drawn complaints from consumer rights groups who worry that hospitals will use credit ratings to determine whether or not to provide elective and other non-emergency care. Consumer groups also worry that hospitals could force individuals to tap into credit lines or other assets in order to cover the costs of bills.

Hospital officials, on the other hand, say that they are not using financial information to deny care but to direct charity care to the neediest patients. For example, one woman qualified for charity care knee surgery after providing a detailed financial history to demonstrate that she couldn't afford to pay the bills on her own. At the non-profit hospital Orlando Regional Healthcare, billing staff are classifying patients by likelihood of paying and focusing on getting "moderate risk" patients to pay their bills before they become delinquent.

Blue Cross Blue Shield of South Carolina has begun to seek partnerships with international hospitals in order to encourage policyholders to seek more cost-effective treatments abroad. The insurer has already established agreements with seven overseas hospitals and hopes to add another five within the year. Blue Cross officials are hoping that encouraging medical tourism for planned medical care will help control costs, since, as Business Week notes, "An insurance company could waive all deductibles and co-pays, offer to cover travel costs for the patient and family members, even throw in a cash incentive, and still save tens of thousands of dollars" without sacrificing quality.

Humana has announced that it will launch a pilot program in Florida to improve care coordination for chronically ill seniors. The program, which will be offered through Medicare Advantage and is an extension of a Medicare pilot, employs social workers, nurses and other health professionals to help individuals manage chronic diseases and avoid the hospital. Under the early Medicare pilot, for example, a nurse visited a 95 year old patient with mobility problems who had been leaning heavily on walls and furniture to get around the house. The nurse arranged to have a bench installed in the patient's house-paid for by the insurer-to prevent falls that could lead to health problems. The program also aims to help patients with multiple chronic health problems manage their conditions.

Wal-Mart announced plans to partner with local doctors and hospitals to roll-out as many as 400 retail clinics over the next two years. By running clinics in partnership with local providers, the company hopes to assuage criticism from the American Medical Association and other physician groups that say that retail clinics erode primary care and compromise patient safety by using nurse practitioners and physician's assistants to treat patients. In addition, Wal-Mart officials say they hope the partnerships with local hospitals will encourage middle and upper income individuals to use the clinics.   

Both Cigna and Aetna have begun to reimburse doctors who consult with patients through e-mail, chatting and other online tools. The insurers are paying-anywhere from $25 to $125-for patients to seek follow-up care with primary care doctors, as well as for treatments for simple problems such as sore throats or fevers. Some specialists are also using the online tools, coupled with at-home monitoring devices, to monitor patients with chronic illnesses.